摘要目的 探讨硬脊膜动静脉瘘(SDAVF)的诊断及其显微手术治疗方法.方法 回顾性分析东部战区总医院神经外科2008年5月至2018年5月收治的14例SDAVF患者的临床资料.所有患者术前均行脊髓MRI和脊髓血管造影检查,明确SDAVF的部位和瘘口的位置.14例患者均行经半椎板入路SDAVF切除术.采用改良Aminoff-Logue评分评估患者术前、术后以及随访期间的脊髓功能.结果 14例患者术后行脊髓血管造影均未见瘘121和迂曲扩张的引流静脉.改良Aminoff-Logue评分[以中位数(上、下四分位数)表示]方面,14例患者术前、术后的步态评分分别为2.0(1.0,3.0)分和2.0(1.0,2.0)分,小便评分分别为2.0(0,2.0)分和1.0(0,2.0)分,大便评分分别为1.0(0,2.0)分和0.5(0,1.0)分,术后各项评分较术前均有改善(均P<0.05).14例患者中,6例失随访;8例术后获随访,随访时间的中位数(上、下四分位数)为7.5(4.5,12.0)个月,其步态、小便以及大便评分分别为0.5(0,1.0)分、0(0,0.7)分以及0(0,0.5)分,各项评分均较术前有改善(均P<0.05).8例患者末次随访时复查脊髓血管造影未见病变复发.结论 脊髓血管造影是诊断SDAVF的金标准,采用经半椎板人路显微手术是治疗SDAVF的有效方法,患者的脊髓功能可获得明显改善.

abstractsObjective To analyze the diagnosis and treatment of spinal dural arteriovenous fistula(SDAVF). Methods The clinical data of 14 patients with SDAVF admitted to Department of Neurosurgery, General Hospital of the Eastern Theater Command from May 2008 to May 2018 were analyzed retrospectively. All patients underwent the examinations of preoperative spinal cord MRI and spinal cord angiography to identify the region of SDAVF and the location of fistula. Microsurgical resection of SDAVF was conducted via semi-1amina approach. The modified Aminoff-Logue score was used to evaluate the spinal function before operation, after operation and during the follow-up period. Results No abnormal fistulas or tortuous dilated drainage veins were detected by spinal cord angiography after operation in 14 patients. The modified Aminoff-Logue score[median(upper and lower quartiles)] before operation and post operation in those 14 patients were as follows:gait:2. 0(1. 0, 3. 0)points vs. 2. 0(1. 0, 2. 0)points, urinate:2. 0(0, 2. 0)points vs. 1. 0(0, 2. 0)points, defecate:1. 0(0, 2. 0)points vs. 0. 5(O, 1. O)points. The postoperative scores were improved compared to preoperative scores(all P＜0. 05). Of those 14 patients, 6 were lost to follow-up and 8 were followed up for 7. 5(4. 5, 12. 0)months. The gait, urinate and defecate scores were 0. 5(0, 1. O), 0(0, 0. 7)and 0(0, 0. 5)respectively, which have improved compared with those before operation(all P＜0. 05). No recurrence of the lesion was found in 8 patients during the last follow-up. Conclusions Spinal cord angiography is the gold standard for the diagnosis of SDAVF. Microsurgery via semi-lamina approach is an effective method for the treatment of SDAVF. The spinal cord function of patients can be improved significantly.