Department of Neurosurgery, Lille University Hospital, Rue E. Laine, 59037, Lille Cedex, France.
INSERM, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, F-59000, Lille, France.
Neurosurg Rev. 2023 Sep 5;46(1):225. doi: 10.1007/s10143-023-02131-z.
Accounting for 70% of all spinal vascular malformations, spinal dural arteriovenous fistulas (SDAVF) are the most common type of malformation. Interruption of the fistulous arterialized vein point is the goal of surgical treatment. The aim of the study was to compare open surgery (laminectomy) versus minimal invasive surgery (MIS) in SDAVF treatment. Between March 2013 and March 2020, we retrospectively collected 21 consecutive adult patients with SDAVF. Since March 2017, MIS has been routinely used for surgical treatment. Pre- and post-operative clinical evaluations used Aminoff-Logue score (ALS). Complication rate was noted. Post-operative occlusion of the malformation was confirmed by digital subtraction angiography (DSA) in all patients. MIS was compared to open surgery in terms of efficacy and complications with statistical evaluation. Standard laminectomy was performed in 12 patients and MIS technique in 9 patients. No difference was noted on pre-operative parameters. ALS and MRI signs of myelopathy were improved in all cases except for 1 patient in each group. All SDAVFs were excluded based on post-operative DSA. Significant differences were noted between the 2 groups in terms of perioperative blood loss (p<0.001), post-operative pain visual analog scale values (p<0.001), and first time out of bed (p<0.001). Wrong level surgery occurred in one patient in each group; patients were re-operated using the same technique. No infection or cerebrospinal fluid (CSF) leak was noted. In our experience, MIS is a safe alternative to open laminectomy for SDAVF treatment. MIS contributes to patient comfort and minimizes blood loss without increasing complication rate.
占所有脊髓血管畸形的 70%，脊髓动静脉瘘（SDAVF）是最常见的畸形类型。瘘动脉化静脉点的阻断是手术治疗的目标。本研究旨在比较 SDAVF 治疗中的开放性手术（椎板切除术）与微创性手术（MIS）。在 2013 年 3 月至 2020 年 3 月期间，我们回顾性地收集了 21 例连续的成人 SDAVF 患者。自 2017 年 3 月以来，MIS 已常规用于手术治疗。术前和术后的临床评估采用 Aminoff-Logue 评分（ALS）。记录并发症发生率。所有患者均通过数字减影血管造影（DSA）确认术后畸形闭塞。将 MIS 与开放性手术在疗效和并发症方面进行比较，并进行统计学评估。12 例患者行标准椎板切除术，9 例患者行 MIS 技术。术前参数无差异。除每组 1 例患者外，所有病例的 ALS 和脊髓病 MRI 征象均得到改善。所有 SDAVF 均根据术后 DSA 排除。两组在围手术期出血量（p<0.001）、术后疼痛视觉模拟评分值（p<0.001）和首次下床时间（p<0.001）方面存在显著差异。每组各有 1 例患者手术部位错误；使用相同的技术对患者进行再次手术。未发生感染或脑脊液（CSF）漏。根据我们的经验，MIS 是治疗 SDAVF 的一种安全的替代开放性椎板切除术的方法。MIS 有助于提高患者舒适度，减少出血量，而不会增加并发症发生率。
