Meisel H J, Lasjaunias P, Brock M
Department of Neurosurgery, Universitätsklinikum Steglitz, Freie Universität, Berlin, Germany.
Minim Invasive Neurosurg. 1995 Dec;38(4):138-45. doi: 10.1055/s-2008-1053474.
Spinal arteriovenous shunts affect all age groups from neonates to the elderly in connection with different entities. The authors present 7 illustrative cases of spinal and spinal cord vascular lesions with different etiology, angioarchitecture, symptoms, risks, and prognosis, but similar pathophysiology: spinal cord AVM, multifocal AVM with venous impairment, paraspinal arteriovenous fistulas in children, spinal dural AV fistula, and an arteriovenous malformation of the filum terminale. Therapy was consistent and demonstrated the benefit of combined treatment. Specific endovascular embolisation with a permanent liquid substance (NBCA) is the method of choice. In 5 of the 7 patients, the malformation was completely occluded in one therapeutic session. Two patients needed additional embolisation. Systemic or neurological symptoms improved or regressed completely in all cases. No patient has had more than 3 sessions of endovascular approach. The filum terminale AVM was treated by direct surgery due to the risks of endovascular approach. As shown by our observations, venous flow in the intrinsic network of the spinal cord is highly sensitive to hemodynamic changes. Thus, the hemodynamic balance must be maintained to obtain stable embolisation results, particularly if a considerable size reduction of the AV shunt has been achieved.
脊髓动静脉分流可累及从新生儿到老年人的所有年龄组，与不同的病变相关。作者展示了7例具有不同病因、血管构筑、症状、风险和预后，但病理生理相似的脊髓和脊髓血管病变病例：脊髓动静脉畸形、伴有静脉损害的多灶性动静脉畸形、儿童椎旁动静脉瘘、脊髓硬脊膜动静脉瘘以及终丝动静脉畸形。治疗方法一致，并证明了联合治疗的益处。使用永久性液体物质（NBCA）进行特异性血管内栓塞是首选方法。7例患者中有5例在一次治疗中畸形完全闭塞。2例患者需要追加栓塞。所有病例的全身或神经症状均有改善或完全消退。没有患者接受超过3次血管内治疗。由于血管内治疗的风险，终丝动静脉畸形采用直接手术治疗。正如我们的观察所示，脊髓固有网络中的静脉血流对血流动力学变化高度敏感。因此，必须维持血流动力学平衡以获得稳定的栓塞结果，特别是在动静脉分流已显著缩小的情况下。
