O'Reilly Sean T, Hendriks Eef Jacobus, Brunet Marie-Christine, Itsekson Ze'ev, Shahrani Rabab Al, Agid Ronit, Nicholson Patrick, terBrugge Karel, Radovanovic Ivan, Krings Timo
1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
2Department of Neuroradiology, Royal Victoria Hospital, Belfast, County Antrim, United Kingdom; and.
J Neurosurg Spine. 2022 May 6;37(4):624-628. doi: 10.3171/2022.3.SPINE22225. Print 2022 Oct 1.
Spinal dural arteriovenous fistulas (SDAVFs) typically represent abnormal shunts between a radiculomeningeal artery and radicular vein, with the point of fistulization classically directly underneath the pedicle of the vertebral body, at the dural sleeve of the nerve root. However, SDAVFs can also develop in atypical locations or have more than one arterial feeder, which is a variant of SDAVF. The aim of this study was to describe the incidence and multidisciplinary treatment of variant SDAVFs in a single-center case series.
Following institutional review board approval, the authors retrospectively analyzed their prospectively maintained database of patients with SDAVFs who presented between 2008 and 2020. For all patients, spinal digital subtraction angiograms were reviewed and variant SDAVFs were identified. Variant types of SDAVFs were defined as cases in which the fistulous point was not located underneath the pedicle. Patient demographics, angiographic features, clinical outcomes, and treatment modalities were assessed.
Of 59 patients with SDAVFs treated at the authors' institution, 4 patients (6.8%) were identified as having a variant location of the shunt zone, pinpointed on the dura mater at the intervertebral level, further posteriorly within the spinal canal. In 3 cases (75%), a so-called bimetameric arterial supply was demonstrated.
Recognition of the variant type of SDAVF is crucial for management, as correct localization of the fistulous point and bimetameric supply are critical for successful surgical disconnection, preventing delay in achieving definitive treatment.
脊髓硬脊膜动静脉瘘（SDAVF）通常表现为神经根脑膜动脉与神经根静脉之间的异常分流，瘘口通常直接位于椎体椎弓根下方、神经根的硬脊膜袖套处。然而，SDAVF也可发生在非典型部位或有不止一个动脉供血支，这是SDAVF的一种变异类型。本研究的目的是在单中心病例系列中描述变异型SDAVF的发生率及多学科治疗情况。
经机构审查委员会批准后，作者回顾性分析了他们前瞻性维护的2008年至2020年间就诊的SDAVF患者数据库。对所有患者的脊髓数字减影血管造影进行回顾并识别变异型SDAVF。SDAVF的变异类型定义为瘘口不在椎弓根下方的病例。评估患者的人口统计学特征、血管造影特征、临床结局和治疗方式。
在作者所在机构接受治疗的59例SDAVF患者中，4例（6.8%）被确定为分流区域位置变异，位于椎管内椎间盘水平的硬脊膜上、更靠后的位置。3例（75%）显示有所谓的双节段动脉供血。
认识SDAVF的变异类型对治疗至关重要，因为瘘口的正确定位和双节段供血对成功进行手术切断、防止延迟获得确定性治疗至关重要。
