Mourier K L, Gobin Y P, George B, Lot G, Merland J J
Département des Maladies du Système Nerveux, Hôpital Lariboisière, Paris, France.
Neurosurgery. 1993 Jun;32(6):885-91; discussion 891. doi: 10.1227/00006123-199306000-00001.
A series of 35 patients treated for an intradural perimedullary arteriovenous fistula (AVF) between 1970 and 1990 is reported. Angiography was performed on all of the patients, leading to the diagnosis. The patients were classified into Type I (4 patients), Type II (9 patients), and Type III (22 patients). One Type I patient was not treated, two others underwent surgery, and the last one was embolized. All of the Type II AVFs were treated, two by embolization, four by direct surgery, and three by surgery after incomplete embolization. All of the Type III AVFs were treated by endovascular detachable silicone balloon. Complete occlusion of the AVF was achieved in all treated cases of Types I and II AVF and in 15 cases of Type III AVF; for the 6 other cases of Type III AVF, incomplete occlusion was achieved. In the Types I and II AVFs, partial improvement was clinically observed in only half of the patients; the others remained unchanged. The 15 patients whose Type III AVF was completely embolized recovered completely, and four patients with Type III AVF who were incompletely embolized remained unchanged; 2 other patients with Type III AVF worsened after incomplete occlusion, and 1 additional patient died a few hours after an attempt of endovascular occlusion of a cervical Type III AVF. The place of the perimedullary AVFs among the other vascular malformations involving the spinal cord is discussed according to this classification into three types. Their specific diagnostic and therapeutic difficulties are discussed, resulting in a simplified classification including two types of perimedullary AVF.
本文报告了1970年至1990年间接受治疗的35例硬脊膜内髓周动静脉瘘（AVF）患者。所有患者均进行了血管造影以明确诊断。患者被分为I型（4例）、II型（9例）和III型（22例）。1例I型患者未接受治疗，另外2例接受了手术，最后1例进行了栓塞治疗。所有II型AVF均接受了治疗，2例通过栓塞治疗，4例通过直接手术，3例在不完全栓塞后进行了手术。所有III型AVF均采用血管内可脱性硅胶球囊治疗。I型和II型AVF的所有治疗病例以及15例III型AVF实现了AVF的完全闭塞；另外6例III型AVF实现了不完全闭塞。在I型和II型AVF中，仅一半的患者临床症状部分改善，其他患者症状无变化。15例III型AVF完全栓塞的患者完全康复，4例III型AVF不完全栓塞的患者症状无变化；另外2例III型AVF不完全闭塞后病情恶化，1例患者在尝试对颈段III型AVF进行血管内闭塞后数小时死亡。根据这种分为三种类型的分类方法，讨论了髓周AVF在其他累及脊髓的血管畸形中的位置。讨论了它们具体的诊断和治疗难点，从而得出一种简化的分类方法，包括两种类型的髓周AVF。
