脊髓硬膜动静脉瘘：单中心回顾性队列研究中手术和/或血管内治疗的结果报告。

Spinal dural arteriovenous fistulas: a report on outcomes in a single-center retrospective cohort treated surgically and/or endovascularly.

机构信息

Hrvoje Barić, Clinical Hospital Center Zagreb, Department of Neurosurgery, Kišpatićeva 12, 10 000 Zagreb, Croatia,

出版信息

Croat Med J. 2021 Aug 31;62(4):347-352. doi: 10.3325/cmj.2021.62.347.

DOI:10.3325/cmj.2021.62.347

PMID:34472737

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8491055/

Abstract

AIM

To report on the outcomes of spinal dural arteriovenous fistulas (sDAVFs) treatment in a single-center retrospective cohort.

METHODS

Data were retrieved on sDAVF cases treated surgically and endovascularly between January 2009 and January 2020. Sociodemographic, clinical, imaging data, and outcomes were analyzed.

RESULTS

Thirty-four patients were identified: 11 female, mean age 64.1 ± 11.5 years; mean time of symptom duration 12 (range 1-149) months. The sDAVF locations were the following: 18 (62.1%) thoracic, 4 (13.8%) lumbar, 4 (13.8%) sacral, and 3 (10%) with multiple location feeders. All patients had a motor deficit and affected walking, and the majority had a sensory deficit, bowel, and bladder dysfunction. Fifteen (44.1%) patients underwent surgical treatment, 7 (20.6%) underwent endovascular treatment, and 12 (35.3%) underwent both (crossover). Radiological myelopathy showed regression in 19 (55.9%) patients. Overall, clinical improvement (decrease in modified Rankin score) following treatment was observed in 14 patients (41.2%), worsening in 1 (2.9%), while other had unchanged status. The proportion of patients with initial treatment failure markedly differed between the before-2014 and after-2014 period. Patients who failed to improve had more extensive myelopathy.

CONCLUSION

Patients who underwent surgery or endovascular treatment had on average significant clinical recovery, while those who underwent treatment crossover had negligible improvement. The extent of myelopathy seems to be associated with clinical improvement.

摘要

目的

报告单中心回顾性队列中脊髓动静脉瘘（sDAVF）的治疗结果。

方法

检索了 2009 年 1 月至 2020 年 1 月期间接受手术和血管内治疗的 sDAVF 病例的数据。分析了社会人口统计学、临床、影像学数据和结果。

结果

共确定了 34 例患者：11 例女性，平均年龄 64.1±11.5 岁；症状持续时间平均为 12（范围 1-149）个月。sDAVF 部位如下：18 例（62.1%）胸段，4 例（13.8%）腰段，4 例（13.8%）骶段，3 例（10%）有多个部位供血。所有患者均有运动障碍和行走障碍，大多数有感觉障碍、肠和膀胱功能障碍。15 例（44.1%）患者接受了手术治疗，7 例（20.6%）患者接受了血管内治疗，12 例（35.3%）患者接受了两种治疗（交叉）。19 例（55.9%）患者的放射学脊髓病有所改善。总的来说，治疗后 14 例（41.2%）患者的临床状况（改良 Rankin 评分下降）得到改善，1 例（2.9%）恶化，而其他患者状况无变化。初始治疗失败的患者比例在 2014 年前和 2014 年后有明显差异。未改善的患者脊髓病更广泛。