Chen Xi, Ge Liang, Wan Hailin, Huang Lei, Jiang Yeqing, Lu Gang, Zhang Xiaolong
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
J Interv Med. 2022 May 21;5(2):111-115. doi: 10.1016/j.jimed.2022.03.001. eCollection 2022 May.
Spinal epidural hemorrhages (SEDH) caused by spinal epidural arteriovenous fistulas (SEAVFs) are rare; thus, their specific pathogenesis has not been explained. Furthermore, the standard treatment for SEAVFs has not yet been defined. Here we report the case of a 36-year-old Chinese man who experienced acute onset chest pain and tightness. His symptoms rapidly aggravated until the lower limbs were unable to support him. Spinal magnetic resonance angiography (MRA) revealed a localized SEAVF and a secondary spinal cord lesion at the T4 level. Digital subtraction angiography (DSA) confirmed the presence of the SEDH/SEAVF at the T3-4 level with the left radicular artery feeding the fistula. Based on DSA and MRA findings, SEDH, local spinal cord infarction, and spinal venous reflux disorder were conditionally diagnosed. Using the arterial route, Onyx-34 was injected into the fistula to embolize the feeding arteries and the venous system. Angiography was performed after the microcatheter was withdrawn, and no residual fistula or anterior spinal artery was observed. The six-week follow-up MRI showed acceptable healing of the SEAVF, and the patient improved neurologically. This case suggests that endovascular treatment with Onyx-34 embolization should be considered a promising treatment strategy for this type of complicated SEAVF.
由硬脊膜外动静脉瘘（SEAVF）引起的硬脊膜外出血（SEDH）较为罕见；因此，其具体发病机制尚未明确。此外，SEAVF的标准治疗方法尚未确定。在此，我们报告一例36岁中国男性病例，该患者突发胸痛和胸闷。其症状迅速加重，直至下肢无法支撑身体。脊髓磁共振血管造影（MRA）显示T4水平存在局限性SEAVF及继发性脊髓病变。数字减影血管造影（DSA）证实T3 - 4水平存在SEDH/SEAVF，瘘由左侧神经根动脉供血。根据DSA和MRA结果，初步诊断为SEDH、局部脊髓梗死及脊髓静脉回流障碍。经动脉途径，将Onyx - 34注入瘘口以栓塞供血动脉和静脉系统。撤出微导管后进行血管造影，未观察到残留瘘口或脊髓前动脉。六周后的随访MRI显示SEAVF愈合良好，患者神经功能有所改善。该病例表明，采用Onyx - 34栓塞的血管内治疗应被视为这类复杂SEAVF的一种有前景的治疗策略。
