Broekx Senne, Houben Rik, Stockx Luc, Boulanger Thierry, Gelin Geert, Weyns Frank, De Beule Tom
Department of Neurosurgery, Ziekenhuis Oost-Limburg, 3600, Genk, Belgium.
Department of Neurology, Ziekenhuis Oost-Limburg, 3600, Genk, Belgium.
Brain Spine. 2021 Sep 28;1:100299. doi: 10.1016/j.bas.2021.100299. eCollection 2021.
A causal relationship between SDAVF's and cervical myelopathy is exceedingly rare. 1-2% of these lesions are located at the craniocervical junction of which 12% are caused by arterial feeders from the external carotid artery. A correct diagnosis can be challenging with a high rate of initial misdiagnosis.
Which aspects constitute the most important potential pitfalls in the diagnostic workup and treatment of SDAVF's with feeders from the external carotid artery causing cervical myelopathy?
We performed a PRISMA-guided review of the literature in which fourteen articles were included. We illustrate the diagnostic hazards through one of our own cases.
SDAVF's at the cervical segment contain unique clinical and radiographic characteristics which differ from those elsewhere. Cervical myelopathy is caused by a SDAVF in 2.3% of cases. Pitfalls are numerous and diagnosis can be challenging, due to a broad differential diagnosis, potential isolated lower extremity involvement and absence of spinal cord edema on MRI. MR-alterations not always correlate with fistula localization.
A SDAVF should be part of the differential diagnosis in patients with subacute tetraparesis. When MRI shows signal alterations in combination with enlarged perimedullary vessels, a SDAVF should be suspected. Spinal angiography should include the vertebrobasilar system, as well as the internal and external carotid arteries. Early and adequate occlusion by means of an endovascular or neurosurgical approach of the draining radicular veins should be pursued. A multidisciplinary approach is key in the diagnostic workup and treatment of these patients.
硬脊膜动静脉瘘（SDAVF）与颈髓病之间的因果关系极为罕见。这些病变中有1-2%位于颅颈交界处，其中12%由来自颈外动脉的供血动脉引起。正确诊断具有挑战性，初始误诊率很高。
对于由颈外动脉供血导致颈髓病的SDAVF，在诊断检查和治疗中，哪些方面构成最重要的潜在陷阱？
我们按照PRISMA指南对文献进行了综述，纳入了14篇文章。我们通过自己的一个病例来说明诊断风险。
颈段的SDAVF具有独特的临床和影像学特征，与其他部位不同。2.3%的病例中颈髓病由SDAVF引起。陷阱众多，诊断具有挑战性，这是由于鉴别诊断范围广、可能仅累及下肢以及MRI上无脊髓水肿。MRI改变并不总是与瘘管定位相关。
SDAVF应作为亚急性四肢轻瘫患者鉴别诊断的一部分。当MRI显示信号改变并伴有髓周血管增粗时，应怀疑SDAVF。脊髓血管造影应包括椎基底系统以及颈内、外动脉。应通过血管内或神经外科方法尽早充分闭塞引流神经根静脉。多学科方法是这些患者诊断检查和治疗的关键。
