摘要
目的对硬脊膜动静脉瘘病例的诊断及治疗进行分析。方法回顾性分析2009年1月-2017年12月解放军第306医院收治的9例硬脊膜动静脉瘘病例。其中男性8例,女性1例,年龄33~68岁,因下肢感觉、运动障碍以及尿便功能障碍等症状就诊,经磁共振及脊髓血管造影检查确诊后,6例接受了显微手术治疗,3例接受了介入栓塞治疗。结果于外院就诊时,9例硬脊膜动静脉瘘患者中7例曾误诊。至我院就诊经脊髓血管造影明确该病诊断后,通过分析MRI表现,可以得出部分脊髓内连续跨多节段的片状长T2 WI影像合并髓周蚓状血管流空影往往提示瘘口位于胸段,而腰骶管内的蛇形血管流空影往往提示瘘口位于腰段的结论。接受手术或介入治疗后,部分患者症状得到缓解。结论临床医师对该病认识不够,该病首诊误诊率较高,延长了病程。而该病的早期诊断并早期治疗对神经功能损伤的恢复具有积极意义。对MRI的充分解读有利于该病的早期诊断。
Objective To explore the diagnosis and treatment of spinal dural arteriovenous fistula. Methods From January 2009 to December 2017, clinical data about 9 patients with spinal dural arteriovenous fistula treated in the 306th Hospital of PLA were retrospectively analyzed. Of the 9 cases, there were 8 males and 1 female with the age of 33-68 years old. The patients admitted to hospital due to sensation, motor dysfunction of lower extremities, or urinary excretion dysfunction. After MRI and DSA examinations, spinal dural arteriovenous fistula were diagnosed. Six patients underwent microsurgery and 3 underwent interventional embolization. Results Because of insufficient knowledge of the disease, 7 out of 9 cases were misdiagnosed in other hospitals. The diagnosis of the disease was confirmed by myelography in our hospital. On T2-weighted images, high-intensity areas across multiple segments of the spinal cord combined with signal flow voids around spinal cord indicated that the fistula located in the thoracic segment, while the serpentine flow voids in the lumbosacral canal indicated that the fistula located in the lumbar segment. All patients underwent surgical clipping of fistula or interventional embolization, and some patients＇ symptoms were relieved. Conclusion Spinal dural arteriovenous fistula is frequently misdiagnosed due to insufficient knowledge of this disease, thus the course of disease is prolonged. Full recognition of MRI is beneficial to the early diagnosis of the disease which has positive significance for the recovery of neurological function imparment.
作者
王培新
王乐凯
尚爱加
WANG Peixin;WANG Lekai;SHANG Aijia(Department of Neurosurgery,Chinese PLA General Hospital,Beijing 100853,China;The 306th Hospital of PLA,Beijing 100101,China)
出处
《解放军医学院学报》
CAS
2018年第8期659-662,共4页
Academic Journal of Chinese PLA Medical School
关键词
硬脊膜动静脉瘘
显微手术
影像诊断
spinal dural arteriovenous fistula
microsurgery
imaging diagnosis
