寰枕交界区硬脊膜动静脉瘘的临床研究

摘要

目的 研究寰枕交界区硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床特点及诊疗措施.方法 回顾性分析8例寰枕交界区SDAVF病人的临床资料,其中6例因蛛网膜下腔出血表现为急性发病;2例慢性发病,表现为感觉运动障碍.7例采用显微手术夹闭治疗,1例双侧动静脉瘘病人采用介入栓塞治疗.结果 手术夹闭的7例病人术后造影显示:瘘口均消失.采用介入栓塞治疗的1例病人,仅栓塞一侧瘘口.随访8例,时间3个月～4年,急性发病病人中1例死于急性心肌梗死,余5例无复发;2例慢性发病病人肌力均得到改善.结论 大部分寰枕交界区SDAVF的首发症状表现为蛛网膜下腔出血引起的急性发病,显微手术夹闭瘘口为首选方法.%Objective To study the clinical features,diagnosis and treatment measures of spinal dural arteriovenous fistula (SDAVF) at the atlanto-occipital junction.Methods Clinical data of 8 patients with SDAVF at the atlanto-occipital junction were analyzed retrospectively.Acute onset was found in 6 patients because of subarachnoid hemorrhage and chronic onset in 2 who showed sensorimotor dysfunction.Microsurgical clipping was performed on 7 patients and interventional embolization on 1 with bilateral SDAVF.Results Postoperative angiography showed all fistulas disappeared in 7 patients who received clipping.One side fistula embolization was achieved in 1 patient who received embolization.Eight patients were followed up for 3 months to 4 years.One of acute onset patients died of acute myocardial infarction and the other 5 had no relapse.The muscle strength was improved in 2 patients with chronic onset.Conclusion For the majority of SDAVF patients at the atlanto-occipital junction,the first symptom is the acute onset of subarachnoid hemorrhage and microsurgical clipping is the first choice.