Nagashima C, Miyoshi A, Nagashima R, Ogawa M, Enomoto K, Watabe T
Department of Neurosurgery, Saitama Medical School, Japan.
Surg Neurol. 1996 Jun;45(6):524-31; discussion 531-2. doi: 10.1016/0090-3019(95)00433-5.
Giant intradural perimedullary arteriovenous fistula with massive spinal cord compression is rare. The therapeutic difficulties include whether endovascular embolization or direct surgical excision should be selected. We present a patient with the largest giant spinal intradural perimedullary arteriovenous fistula shown by magnetic resonance imaging so far reported, who was successfully treated by a combination of endovascular embolization and direct surgery.
A 16-year-old girl presented with a giant intradural arteriovenous fistula (perimedullary Type II) at the C4-5 level, manifesting as progressive cervical myeloradiculopathy. The single-hole fistula was supplied by the anterior spinal artery and an ascending artery arising from both the costocervical and highest intercostal arteries with a rapid transit time, and drained superiorly to the foramen magnum, and inferiorly to the thoracic spinal canal, through a huge venous lake at the site of the arteriovenous connection. The patient was treated by transarterial embolization with platinum coils and silk, followed by surgical excision with excellent results at 12 months' follow-up.
We recommend that such a huge perimedullary arteriovenous fistula with a rapid transit time, and severe cord and root compression, should be treated with embolization followed by surgical excision.
巨大的硬脊膜内髓周动静脉瘘伴严重脊髓压迫较为罕见。治疗难点包括应选择血管内栓塞还是直接手术切除。我们报告一例患者，其磁共振成像显示为迄今报道的最大的巨大脊髓硬脊膜内髓周动静脉瘘，通过血管内栓塞和直接手术联合治疗获得成功。
一名16岁女孩，在C4 - 5水平出现巨大的硬脊膜内动静脉瘘（髓周II型），表现为进行性颈段脊髓神经根病。单孔瘘由脊髓前动脉以及发自肋颈干和最上肋间动脉的一支升动脉供血，血流通过时间短，通过动静脉连接处的巨大静脉湖向上引流至枕大孔，向下引流至胸段椎管。该患者接受了铂圈和丝线经动脉栓塞治疗，随后进行手术切除，随访12个月效果良好。
我们建议，对于这种血流通过时间短、伴有严重脊髓和神经根压迫的巨大髓周动静脉瘘，应先进行栓塞治疗，然后再进行手术切除。
