36例经血管内栓塞或显微手术治疗的骶硬膜动静脉瘘患者的长期预后。

IF 2.6 1区 医学
Yu Duan, Xuanfeng Qin, Qinyi Chen, Binbin Xu, Qinzhu An, Yujun Liao, Yuanyuan Hu, Gong Chen
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引用次数: 0

摘要

目的:骶硬膜动静脉瘘是一种罕见的脊柱血管畸形,常被误诊甚至误治。本研究旨在探讨SDAVF的临床特征、血管结构和治疗结果,以提高未来的诊断和治疗方法。方法:回顾性分析2014年3月至2022年3月连续发生的SDAVF患者。对患者的人口统计学、症状缓解情况、血管建筑学特征及术后病程进行研究。采用改良的Aminoff-Logue量表评价脊髓功能。结果:共纳入36例sdavf患者,其中12例在初次就诊时被误诊。sdavf分别位于S1 24例(66.7%)、S2 10例(27.8%)和S3 2例(5.6%)。主要供血动脉包括髂内动脉骶外侧动脉(LSA)(31/36, 86.1%)、髂外动脉分支(2/36,5.6%)和正中动脉分支(3/36,8.3%),大部分为直支。终末静脉是唯一的引流静脉,回流至髓周静脉网络。30例以血管内栓塞治疗为主,6例采用显微外科造瘘术治疗。MRI检查显示髓质周围异常血管信号消失,多数病例脊髓水肿减轻(32/36,88.9%)。6例患者均首次行血管内栓塞治疗,术后残余或复发,其中2例再次行显微外科瘘管切除术。所有显微外科瘘管切除术患者在随访期间均无残留或复发。根据脊髓功能评估,术后Aminoff-Logue评分明显降低(Z=-3.449, p=0.001)。结论:SDAVF误诊率高。SDAVF供血最多的动脉来自于LSA,它更粗、更直,使得微导管更容易到达瘘管部位。因此,血管内栓塞已成为微创、安全有效的首选治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term outcome in a cohort of 36 patients with sacral dural arteriovenous fistulae after endovascular embolisation or microsurgery.

Objective: Sacral dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation and often misdiagnosed or even mistreated. This study delved into the clinical characteristics, vascular architecture and treatment results of SDAVF, with the goal of enhancing upcoming diagnostic and therapeutic methodologies.

Methods: From March 2014 to March 2022, consecutive patients with SDAVF were retrospectively analysed. The data on demographics, symptom resolution, angioarchitectural features and postoperative course were studied. Spinal cord function was evaluated by modified Aminoff-Logue scale.

Results: A total of 36 patients with 36 SDAVFs were enrolled, 12 of whom were misdiagnosed on their initial visit. The SDAVFs were located at S1 in 24 (66.7%), S2 in 10 (27.8%) and S3 in 2 (5.6%) cases, respectively. The primary feeding arteries included lateral sacral artery (LSA) of internal iliac artery (31/36, 86.1%), the branches of external iliac artery (2/36, 5.6%) and median artery (3/36, 8.3%), most of which are straight. Venae terminalisis is the sole drainage vein, flowing back into perimedullary venous network. Endovascular embolisation is the main therapy method for 30 cases, while the other 6 cases were treated with microsurgical fistulectomy. MRI tests showed that the abnormal vascular signals around the medulla disappeared, and the spinal cord oedema was alleviated in the majority of cases (32/36, 88.9%). Six patients, who all were treated by endovascular embolisation at first time, had residual or recurrent and two of them were performed by microsurgical fistulectomy again. All patients by microsurgical fistulectomy had no residual or recurrent during follow-up. According to the spinal cord functional assessment, the Aminoff-Logue score was significantly decreased (Z=-3.449, p=0.001) postoperatively.

Conclusion: The misdiagnosis rate of SDAVF is very high. The most feeding artery of SDAVF came from the LSA, which was thicker and more straight, making it easier for microcatheters to reach the fistula site. So, endovascular embolism has become the first choice of treatment with minimal invasion, and safe and effective results.

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来源期刊
Journal of Investigative Medicine
Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL
自引率
0.00%
发文量
111
期刊介绍: Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.
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