Liu Hon-Man, Lee Chung-Wei, Lin Yen-Heng
Department of Medical Imaging, Fu Jen Catholic University Hospital, New Taipei City, Taipei, Taiwan.
Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Surg Neurol Int. 2025 May 23;16:196. doi: 10.25259/SNI_133_2025. eCollection 2025.
The aim of the study is to present our strategy for stratifying patients with spinal perimedullary arteriovenous fistulas (PMAVFs) and apply the appropriate treatment.
This retrospective study included 23 patients with PMAVF. We divided the patients into three groups according to the location of the fistula and size of the predominant feeder: Group 1 (dorsal PMAVF, = 4), Group 2 (nondorsal PMAVF having a predominant feeder through which the smallest coil-deploying microcatheter could pass, = 6), and Group 3 (nondorsal PMAVF having no feeder through which the smallest available microcatheter could pass, = 13). Group 1 underwent surgical treatment. All patients in Groups 2 and 3 underwent endovascular treatment with a liquid embolic agent, except one in Group 3, who opted for surgical treatment. Coil was used as a supplementary tool for treating lesions in Group 2. Patients' basic and clinical characteristics, treatment, and outcome data were recorded.
Six patients were aged <15 years. Overall, patient fistulas were located in the thoracic region ( = 11), conus region ( = 7), and cervical spine ( = 5). Of the 18 PMAVFs who underwent endovascular treatment, 100% occlusion was observed in 14, 90% in 3, and 75% in 1. Nineteen patients had complete or partial recovery of neurological deficits. Six patients experienced temporary worsening immediately after treatment but recovered within 3 months. No bleeding or rebleeding was noted after either treatment.
Our simple strategy for stratifying PMAVF for treatment is easy to apply in clinical practice and results in favorable outcomes.
本研究的目的是介绍我们对脊髓髓周动静脉瘘（PMAVF）患者进行分层的策略，并应用适当的治疗方法。
这项回顾性研究纳入了23例PMAVF患者。我们根据瘘口位置和主要供血动脉大小将患者分为三组：第1组（背侧PMAVF，n = 4），第2组（非背侧PMAVF，有最小可部署线圈的微导管能够通过的主要供血动脉，n = 6），第3组（非背侧PMAVF，没有最小可用微导管能够通过的供血动脉，n = 13）。第1组接受手术治疗。第2组和第3组的所有患者均接受液体栓塞剂血管内治疗，但第3组中有1例选择了手术治疗。第2组使用线圈作为治疗病变的辅助工具。记录患者的基本和临床特征、治疗及结果数据。
6例患者年龄<15岁。总体而言，患者的瘘口位于胸段（n = 11）、圆锥段（n = 7）和颈椎（n = 5）。在接受血管内治疗的18例PMAVF患者中，14例实现了100%闭塞，3例为90%，1例为75%。19例患者的神经功能缺损得到完全或部分恢复。6例患者在治疗后立即出现短暂恶化，但在3个月内恢复。两种治疗后均未发现出血或再出血。
我们对PMAVF进行治疗分层的简单策略易于在临床实践中应用，并能取得良好的效果。
