马尾神经根动静脉瘘的诊治分析

发布时间：2018-11-02 19:13

【摘要】：目的探讨马尾神经根动静脉瘘的诊断和治疗结果。方法回顾性纳入2000年1月至2015年12月首都医科大学宣武医院诊治的马尾神经根动静脉瘘9例患者,男6例,女3例,年龄17~58岁,平均(39±14)岁。经全脊髓DSA或手术证实诊断(病变位置位于马尾神经上,由滋养神经根的动脉供血,引流静脉向上汇入髓周静脉)。分析患者的临床资料、影像资料和治疗随访结果。结果患者表现为双下肢无力和排尿排便功能障碍,术前脊髓功能AminoffLogue评分(7.2±3.2)分,病程中位数6.0(4.5~18.0)个月。造影显示病变的血管构筑类型分为单纯瘘型和微小畸形团型,供血动脉均为髂内动脉神经根支,3例合并圆锥部位髓内动静脉畸形。血管内栓塞治疗8例,手术治疗1例,无手术相关并发症。平均随访期为(20.1±6.7)个月,影像学随访显示均达解剖治愈,治疗后AminoffLogue评分降至(4.6±2.8)分,治疗前后比较差异有统计学意义(t=4.276,P0.05)。结论马尾神经根动静脉瘘可通过DSA进行诊断,有症状患者符合血管内治疗或手术治疗适应证,治疗后解剖学和功能学预后均得到有效改善。
[Abstract]:Objective to investigate the diagnosis and treatment of cauda equina root arteriovenous fistula. Methods from January 2000 to December 2015, 9 patients with cauda equina arteriovenous fistula were retrospectively included in Xuanwu Hospital of Capital Medical University. There were 6 males and 3 females with an average age of (39 卤14) years. The diagnosis was confirmed by DSA or surgery (the lesion was located on the cauda equina, fed by the artery of the trophoblast nerve root, and the drainage vein flowed upward into the perimedullary vein). Clinical data, imaging data and treatment follow-up results were analyzed. Results the patients presented with lower extremity weakness and defecation dysfunction. The preoperative AminoffLogue score of spinal cord function was (7.2 卤3. 2) and the median course of disease was 6. 0 (4. 5 卤18. 0) months. Angiographic findings showed that the vascular architecture of the lesion was divided into simple fistula type and small malformation type. The blood supplying arteries were all the nerve root branches of the internal iliac artery, and 3 cases were complicated with intramedullary arteriovenous malformation at the conical site. 8 cases were treated by endovascular embolization and 1 case by operation. The average follow-up period was (20.1 卤6.7) months, and the imaging follow-up showed that all of them were anatomic cured, and the AminoffLogue score decreased to (4.6 卤2.8) after treatment. There was significant difference between the two groups before and after treatment (P 0.05). Conclusion cauda equina arteriovenous fistula can be diagnosed by DSA. The symptomatic patients meet the indications of intravascular or surgical treatment. The anatomic and functional outcomes are improved effectively after treatment.
【作者单位】：首都医科大学宣武医院神经外科;
【基金】：国家自然科学基金(81171165,81671202) 北京市医管局扬帆计划(ZY201309) 北京市科委重点项目(D161100003816001)
【分类号】：R651.2

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