摘要
目的探讨显微手术治疗颅颈交界区硬脊膜动静脉瘘(SDAVF)的安全性和有效性。方法回顾性分析2008年12月至2021年12月东部战区总医院神经外科收治的25例行显微手术治疗的颅颈交界区SDAVF患者的临床资料。其中出血患者11例(出血组),均以自发性蛛网膜下腔出血(SAH)急性起病,非出血患者14例(非出血组)。采用Kamofsky功能状态(KPS)评分评估患者术前和术后的健康状况和生活质量,术后定期进行随访。结果11例出血患者术后头部CT示1例患者出现术区出血,其余患者未见出血,且SAH明显减少;CTA未见颅颈交界区异常增粗、迂曲的血管,DSA示瘘口完全闭塞。14例非出血患者术后头颈部MRI示1例患者出现颈段脊髓肿胀,其余患者未见颈段脊髓水肿及血管流空影,MRA未见颅颈交界区异常的血管影,DSA示瘘口完全闭塞。所有患者术中瘘口完全闭塞,术后DSA均无异常。出血组患者术后功能状态较术前明显改善(P<0.001),7例患者随访期间均无不适主诉,复查DSA未见瘘口。非出血组患者术后功能状态较术前明显改善(P<0.001),9例患者随访期间均无不适主诉,复查DSA未见瘘口。结论显微手术是治疗颅颈交界区SDAVF的有效方法,能显著改善患者的预后。
Objective To investigate the safety and efficacy of microsurgery in the treatment of spinal dural arteriovenous fistula(SDAVF)in craniocervical junction.Methods It was analyzed retrospectively the clinical data of 25 patients with craniocervical junction SDAVF who underwent microsurgery in the Department of Neurosurgery of the Eastern Theater General Hospital from December 2008 to December 2021.Among them,11 patients with hemorrhage(hemorrhage group)had acute onset of spontaneous subarachnoid hemorrhage(SAH),and 14 patients without hemorrhage(non-hemorrhage group).The Kamofsky Functional status(KPS)score was used to evaluate the patients'health status and quality of life before and after surgery.Results The head CT of 11 patients showed that 1 patient had intraoperative hemorrhage,the other patients did not have hemorrhage,and SAH was significantly reduced.CTA did not show abnormal thickening and tortuous blood vessels in the craniocervical junction,and DSA showed complete occlusion of the fistula.Postoperative head and neck MRI of the 14 non-bleeding patients showed cervical spinal cord swelling in 1 patient,cervical spinal cord edema and empty vascular shadow were not observed in the other patients,MRA showed no abnormal vascular shadow in the craniocervical junction,and DSA showed complete occlusion of the fistula.All patients had complete occlusion of fistula during operation and no abnormal postoperative DSA.The postoperative functional status of patients in the hemorrhage group was significantly improved compared with that before surgery(P<0.001).No complaints of discomfort were reported in 7 patients during follow-up,and no fistula was found in DSA review.The postoperative functional status of the patients in the non-bleeding group was significantly improved compared with that before surgery(P<0.001).No complaints of discomfort were reported in all the 9 patients during follow-up,and no fistula was found in DSA review.Conclusion Microsurgery is an effective method for the treatment of craniocervical junction SDAVF,which can significantly improve the prognosis of patients.
作者
张力
丁可
李振兴
茅磊
ZHANG Li;DING Ke;LI Zhenxing;MAO Lei(Department of Neurosurgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)
出处
《医学研究与战创伤救治》
CAS
北大核心
2024年第3期267-271,共5页
Journal of Medical Research & Combat Trauma Care
基金
国家自然科学基金(82101461)。
关键词
颅颈交界区硬脊膜动静脉瘘
临床特点
显微手术治疗
craniocervical junction spinal dural arteriovenous fistula
clinical characteristics
microsurgery treatment
作者简介
通信作者:茅磊,E-mail:leiching2021@126.com。
