一例罕见的椎体骨内动静脉瘘合并大硬膜外静脉曲张和椎体塌陷:多模式成像和治疗方案。

IF 1.1 4区 医学 Q3 ORTHOPEDICS
Nitish Gupta, B T Pushpa, Ajoy Prasad Shetty, Shanmuganathan Rajasekaran, Bhupendar Singh
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引用次数: 0

摘要

脊柱动静脉瘘(AVF)是一种罕见的脊柱疾病,而椎骨内AVF的存在是罕见的。文献中记载的病例屈指可数。我们提出一个病例大椎体骨内AVF引起椎体塌陷与相关的大硬膜外静脉囊造成压迫和马尾神经根充血。我们强调该疾病的临床和放射学特征,以及手术前血管内栓塞治疗椎体骨内AVF的重要性。一位22岁的女士以右下肢放射引起的腰痛为主诉。腰骶椎MRI及增强CT显示L5椎体破坏区伴大血管通道。这些通道与前硬膜外间隙存在的多个静脉袋相连。导管血管造影显示这些静脉囊流入椎旁静脉丛。经动脉胶栓技术完全闭塞骨内AVF。栓塞后症状明显减轻。尽管极为罕见,但脊柱骨内avf可发展并引起背痛、充血性脊髓病和压迫性脊髓病等症状。血管内栓塞是脊柱骨内avf的主要治疗方法,可用于需要椎体内固定以稳定脊柱的患者的手术前治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Rare Case of Vertebral Intraosseous Arteriovenous Fistula with Large Epidural Venous Varices and Vertebral Collapse: Multimodal Imaging and Treatment Options.

Spinal arteriovenous fistulas (AVF) are uncommon spinal pathologies and the presence of exclusive intraosseous vertebral AVF is a rarity. Only a handful of cases are documented in the literature. We present a case of large vertebral intraosseous spinal AVF causing vertebral collapse with associated large epidural venous pouches causing compression and congestion of cauda equina nerve roots. We highlight the clinico-radiological features of this entity and the importance of endovascular embolization before surgery in the management of vertebral intraosseous AVF. A 22-year lady presented with complaints of low back ache that had radiation to the right lower limb. MRI and contrast enhanced CT of lumbosacral spine showed areas of L5 vertebral destruction with large vascular channels. These channels were in contiguity with multiple venous pouches present in the anterior epidural spaces. Catheter angiography showed these venous pouches draining into the paravertebral venous plexus. The intraosseous AVF was completely occluded by the techniques of transarterial embolization with glue. The symptoms showed significant reduction after embolization. Although extremely rare, spinal intraosseous AVFs can develop and cause symptoms like back ache, congestive myelopathy and compressive myelopathy. Endovascular embolization is useful for the cases of spinal intraosseous AVFs as the primary treatment method and can be used presurgery in patients requiring vertebral instrumentation for stabilisation of the spine.

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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
185
审稿时长
9 months
期刊介绍: IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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