Lee T T, Gromelski E B, Bowen B C, Green B A
Department of Neurological Surgery, University of Miami School of Medicine, Florida 33101, USA.
Neurosurgery. 1998 Aug;43(2):242-6; discussion 246-7. doi: 10.1097/00006123-199808000-00032.
A retrospective review was conducted to compare magnetic resonance (MR) and conventional spinal angiographic images and to investigate the outcome of our treatment protocol for patients with spinal dural arteriovenous fistulas (DAVFs).
Nine patients with a diagnosis of DAVF based on clinical myelopathy and preoperative MR imaging (MRI) and MR angiography (MRA) findings were treated at our institution by the senior author (BAG). All nine patients initially presented with progressive myelopathy. Preoperative MRI revealed T2-weighted signal abnormalities in all patients, and MRA was diagnostic in all patients. Each patient underwent a laminectomy and ligation of the arterialized draining vein. Selective spinal angiograms were used to confirm the level of fistula immediately before the surgical procedure was performed and to document complete obliteration after clip ligation of the medullary draining vein. Follow-up MRI and MRA were performed approximately 2 months postoperatively.
MRI T2-weighted signal hyperintensity improved after surgery in all nine patients. Postoperatively, progression of motor weakness and gait difficulty was halted and some improvement was observed in all patients. No patient was neurologically normal, however. To date, there has been no clinical or MRA evidence of recurrence in any patient.
Preoperative MRA and intraoperative spinal x-ray angiography present as an effective combination for diagnosing and intraoperatively confirming DAVF. Both T1-weighted enhancement and T2-weighted signal hyperintensity on MR images improved after the obliteration of the DAVFs and correlated with clinical improvement in all nine patients. MRA provides adequate visualization and localization of spinal DAVFs and may serve as a useful noninvasive tool for diagnosing and following patients with spinal DAVFs in the future.
进行一项回顾性研究，比较磁共振（MR）和传统脊髓血管造影图像，并研究我们针对脊髓硬脊膜动静脉瘘（DAVF）患者的治疗方案的结果。
9例基于临床脊髓病以及术前磁共振成像（MRI）和磁共振血管造影（MRA）结果诊断为DAVF的患者在我们机构由资深作者（BAG）进行治疗。所有9例患者最初均表现为进行性脊髓病。术前MRI显示所有患者T2加权像信号异常，MRA对所有患者均具有诊断价值。每位患者均接受了椎板切除术并结扎动脉化引流静脉。在手术即将进行前，使用选择性脊髓血管造影来确认瘘口水平，并在结扎髓周引流静脉后记录完全闭塞情况。术后约2个月进行随访MRI和MRA检查。
所有9例患者术后MRI的T2加权像信号高增强均有所改善。术后，所有患者运动无力和步态困难的进展均停止，且有一定程度改善。然而，没有患者神经功能恢复正常。迄今为止，没有任何患者出现临床或MRA复发证据。
术前MRA和术中脊髓X线血管造影是诊断和术中确认DAVF的有效组合。在DAVF闭塞后，MR图像上的T1加权像强化和T2加权像信号高增强均有所改善，且与所有9例患者的临床改善相关。MRA能够充分显示和定位脊髓DAVF，未来可能成为诊断和随访脊髓DAVF患者的有用无创工具。
