脊髓髓内动静脉畸形合并脊髓空洞症1例

1病历摘要（图1～3） 男，33岁，因进行性双下肢乏力半年余，加重伴吞咽困难1个月余入院。颈胸段MRI检查示延髓至T11脊髓空洞，T7.8髓内占位病变。初步诊断为髓内占位性病变，考虑为动静脉畸形（AVM）并脊髓空洞症。全麻下行T7.8椎板切开探查，脊髓空洞分流术。术后1个月因再次出现吞咽困难而入院，脊髓血管造影示T7肋间动脉至脊髓前动脉供血，血管团直径1.5cm，考虑为T7脊髓髓内AVM。     

国产非黏附性栓塞材料EVAL胶栓塞治疗脑和脊髓动静脉畸形

目的 探讨使用新型国产非黏附性液体胶EVAL(山东赛克赛斯公司)栓塞脑和脊髓动静脉畸形(AVM)的疗效.方法 从2006年7月至2007年12月,经微导管技术庇用EVAL胶栓塞20例脑AVM,3例脊髓AVM.畸形团的位置:8例位于大腩重要功能区,8例位于大脑深部组织区,4例位于小脑半球.颈、胸、腰髓畸形团各1例.畸形团的大小:直径＜3 cm 7例,3 cm～6 cm 10例,＞6 cm 6例.结果 3例畸形团完全消失,5例畸形团消失在90%以上,11例消失50%～90%,4例消失在50%以下.栓塞后2例有短暂神经功能障碍.微导管均成功撤出.结论 非黏附性EVAL胶不粘管,可较多地注入畸形团内,用于栓塞脑和脊髓AVM安全、有效.     

脊髓动静脉畸形:进展中的治疗性栓塞法

脊髓内动静脉畸形(AVMs)直接手术切除的危险性和技术上的困难,导致了发展变换新的治疗方法。脊前动脉阻塞因可产生严重的神经功能缺失,行脊髓内AVMs 栓塞常被认为是一种危险的方法。但是近年来血管内栓塞法的进展已较安全。这些新技术包括使用聚乙烯酒精(polyvinyl alcohol)微粒管,全身性血管数字减影造影及暂时性气囊阻塞来自椎动脉支所供应的颈段AVMs 等。材料和方法:去年一年中,在蒙特利尔神经病医院中有5例脊髓前动脉供应的脊髓AVMs 作了栓塞疗法。颈段和胸腰段髓内AVM 各2例。腰段髓外AVM1例。例1因左下肢根性神经痛和无力首次就诊,脊髓造影显示有许多扩张的血管。脊髓血管造影为胸腰段     

自发性脊髓出血临床及影像学分析

目的 :探讨自发性脊髓出血的病因、临床表现及影像学特征。方法 :回顾分析了 18例经临床、 CT、 MRI或血管造影证实的脊髓出血患者的临床及影像学表现。结果 :本组患者多为突然起病的剧烈神经根痛 ,随后出现运动、感觉及植物神经功能障碍 ;病变在颈段 7例 ,胸段 8例 ,腰段 3例 ;腰穿为血性脑脊液 ;影像学检查尤其是 MRI和DSA能明确病因及部位 ,本组发现脊髓血管畸形 13例 ,血液病 2例 ,其他 3例。结论 :脊髓出血最常见的病因为脊髓血管畸形 ,MRI和 DSA检查有可能在出血前做出病因诊断 ,早期治疗脊髓血管畸形可防止出血发生。     

硬脊膜动静脉瘘的手术治疗(附3例报告)

脊髓血管畸形包括髓内动静脉畸形（AVM）、髓周动静脉瘘和硬脊膜动静脉瘘（AVF）。髓内AVM是指由脊髓动脉供血，位于脊髓髓内的畸形血管团。髓周AVF是脊髓前后动脉与静脉在脊髓周围形成直接交通。而硬脊膜AVF是供应脊膜或神经根的细小动脉，在锥间孔附近与脊髓表面的引流静脉直     

脊髓空洞MRI表现与病因分析

目的分析21例不种病因所致脊髓空洞的MRI表现。方法21例脊髓空洞患者均经手术及病理证实，MRI重点观察脊髓及其空洞的部位、形态和信号特点。结果21例脊髓空洞中，脊髓肿瘤性空洞9例，Chiari畸形所致4例．创伤后空洞4例，自发性脊髓空洞2例．脊柱侧弯2例；空洞累及颈髓或胸髓，空洞均位于脊髓中央管，范围从2～13个脊髓节段不等，空洞内信号变化同脑脊液。结论脊髓空洞主要由于脊髓肿瘤、Chiari畸形、创伤、脊柱侧弯、自发性脊髓空洞等引起，不同病因空洞的MRI表现各不相同，籍此可进行鉴别诊断并分析其病因。     

脊髓成血管细胞瘤的诊断与外科治疗

脊髓成血管细胞瘤比较少见,占脊髓肿瘤的1.6%～2.1%.本文对脊髓成血管细胞瘤的诊断与外科治疗进行探讨.强调MRI检查对其术前诊断的重要性.全组男8例,女2例.年龄21～68岁,平均45岁.经CT、MRI或脊髓血管造影检查明确诊断.2例(20%)系多发性生长(均为2个病灶).肿瘤位于颈段脊髓6个,颈胸段1个,胸段2个,胸腰段1个,园锥2个.其中10个位于髓内,另2个波及髓     

脑动静脉畸形合并动脉瘤18例临床分析

目的探讨脑动静脉畸形(AVM)合并动脉瘤的诊断、分类、治疗和效果。方法对18例确诊脑AVM合并动脉瘤患者的临床资料进行分析。结果全组病例均经全脑数字减影血管造影(DSA)检查确诊。依据Redekop分类法：AVM团内型12例、血流相关型5例、与AVM无关型1例。全部病例均选择先栓塞或夹闭动脉瘤再治疗畸形血管团。术后10例复查DSA，8例示动脉瘤和畸形血管不再显影，2例示动脉瘤不显影但畸形血管残留少许。结论诊断脑AVM合并动脉瘤的金标准是DSA，治疗原则是先夹闭或栓塞动脉瘤，再栓塞、切除或γ-刀治疗AVM。     

3.0T MRI多序列成像与MRA在脑动静脉畸形诊断中的应用

目的探讨3.0T MRI多序列成像并MRA在脑动静脉畸形(AVM)诊断中的应用价值。方法使用飞利浦Achieva3.0TX-series磁共振扫描仪对23例AVM患者行MRI多序列平扫及MRA成像,并对1例患者行增强MRA成像。结果 23例患者中,9例AVM病灶位于左侧大脑半球,另11个AVM病灶位于右侧大脑半球;左右小脑半球各1例,1例位于大脑大静脉池。MRI多序列上,AVM表现为乱线团样异常血管流空信号,供血动脉及粗大引流静脉显示清楚,病灶内陈旧出血及胶质增生伴随小血管呈混杂信号改变。MRA及CE-MRA脑内血管尤其是畸形的异常血管团及供血和引流血管显示完美。结论 3.0T磁共振其多序列MRI并结合MRA成像,可较完美显示脑动静脉畸形的血管解剖关系,同时由于其简便快速,显示脑血管病变客观,对临床确诊和治疗AVM具有指导价值。     

脊髓颈段血管畸形1例报告

脊髓颈段血管畸形１例报告叶桂兰脊髓血管畸形比较少见，临床上需与脊髓肿瘤、脊髓炎、椎间盘脱出、蛛网膜炎鉴别。脊髓血管畸形好发部位为胸腰段，颈段很少见。我们收治１例经手术证实的颈髓血管畸形病人，报告如下：女，２６岁，１９８９年５月１０日入院。１９８６年初...     

Use of different endovascular treatments for arteriovenous malformations of the spinal cord

The paper presents outcomes of treatment of patients with arteriovenous malformations (AVM) of the spinal cord by using endovascular techniques in 171 patients. There were a total of 364 occluded afferent vessels involved in the blood supply to and development of AVM. A classification of spinal cord AVM is presented. Methods for occlusion were described in relation to the type AVM. Malformations were thrombosed with polyvinyl acetate (PVA) emboli in 129 patients; balloon occlusion of afferent vessels was performed in 6, as described by F. A. Serbinenko; histoacryl glue was applied in 27 cases. A combined method of occlusion of afferent vessels was used with PVA emboli and balloons in 9 patients. The clinical picture of spinal cord AVM was outlined. Emphasis is laid on diagnostic methods, such as selective angiography and magnetic resonance imaging, as well as on their role in postoperative control studies, in determining the degree of thrombosis, the presence of ischemic events, and subarachnoidal space patency. Endovascular treatment used in patients with AVM at different levels of the spinal cord alleviated neurological symptoms in 155 (91%) patients. There was no improvement in 12 (7%) patients. Complications at angiography and embolization were observed with deteriorated neurological symptoms in 4 (2%) cases. Further development and improvement of endovascular treatments in patients with spinal cord will be promising if new intervention technologies are introduced in clinical practice.     

Acute flank pain, an unusual first symptom of a spinal arteriovenous malformation.

This case report describes a 46-year-old man whose first symptom was an attack of acute flank pain, followed by the gradual onset neurological symptoms. We demonstrated a small nidus and serpentine signal-void area in the spinal cord by MRI and diagnosed a glomus type of spinal arteriovenous malformation (AVM). Flank pain is a rare initial finding in an adult with spinal AVM. In cases with acute flank pain, neurologists should consider spinal AVM as a differential diagnosis.     

Spinal type IV arteriovenous malformations (perimedullary fistulas) in children

Objects: Intradural perimedullary spinal arteriovenous fistula (AVF) is a synonym for type IV spinal arteriovenous malformation (AVM). It is an important clinical differential diagnosis in all patients with slowly progressive or acute spinal symptoms. Perimedullary AVFs are rare in the paediatric age group. We report the treatment regimen and the clinico-radiological findings for these malformations at our institution. Methods: Of four paediatric patients, three individuals with persistent fistulas after endovascular treatment were operated on. The malformations were obliterated completely in all patients without any morbidity. In three patients previously documented neurological symptoms resolved during follow-up. Conclusions: If slowly progressive or acute radicular or medullary symptoms arise in children, a spinal arteriovenous malformation should be ruled out by MRI. A combined endovascular and surgical treatment of paediatric spinal AVM type IV (perimedullary AVFs) carries a low risk of morbidity and is reasonably effective. Received: 28 December 1999     

A case of a large neonatal arteriovenous malformation with heart failure. Color Doppler sonography,MRI and MR angiography as early non-invasive diagnostic procedures

We report a case of a large arteriovenous malformation (AVM) of neonatal onset with heart failure. Transfontanel color Doppler sonography revealed abnormal vessels in the early stage of the investigation. Magnetic resonance imaging (MRI) revealed numerous flow voids suggesting abnormal vessels, and magnetic resonance angiography (MRA) disclosed numerous bizarre abnormal vessels. Color Doppler sonography is a convenient and appropriate procedure for the early bedside diagnosis of neonatal AVMs. MRI and MRA can replace cerebral angiography for the diagnosis of neonatal AVMs.     

自发性蛛网膜下腔出血脑血管造影阴性的诊治对策

目的 探讨蛛网膜下腔出血(SAH)病人可能存在的出血原因，寻求当首次脑血管造影阴性时的诊治对策。方法 回顾性分析我科近5年来322例SAH出血病人，其中55例病人首次血管造影阴性。结果 17例因再出血或遵医嘱行2次脑血管造影，3例发现颅内动脉瘤，l例发现左颞叶底部脑动静脉畸形(AVM)。2例重复脑血管造影阴性行开颅手术探查，证实分别为前交通动脉瘤和左侧颈内动脉后交通动脉瘤；8例行MRI检查，1例发现胼胝体AVM；8例行CTA检查，1例发现前交通动脉瘤。1例因出现典型的下肢放射痛而行脊髓血管造影，发现L2AVM。结论 对于SAH后首次造影阴性的病人，应行重复血管造影，结合MRI、MRA及CTA检查可提高诊断率，必要时行手术探查。     

脑动静脉畸形的DSA、CT和MR诊断对比研究

回顾性研究1985年2月～1996年8月脑动脉畸形96例，对照分析本病的DSA、CT和MR诊断征象。结果96例DSA表现为供血动脉增粗迂曲，畸形血管团，引流静脉提早显影．58例CT平扫25例显示局部有条索状、团状高密度灶，14例显示高低混杂密度灶。显示低密度灶7例。12例显示正常．增强扫描可见弯曲，粗大明显增强高密度血管影，无水肿及占位效应．14例MR扫描均见流空信号，多为蜂窝状或蚯蚓状，其周围有粗大供血动脉和引流静脉。作者认为DSA是诊断本病的首选检查方法．MR对畸形血管的显示优于CT，但价格昂贵．     

A case of dural arteriovenous malformation in the region of the cavernous sinus improved by Matas procedure

A 55-year-old woman developed the sudden onset of headache and diplopia. The neurological findings showed the left 3rd and 4th cranial nerve palsies, loss of pain and temperature sensation in the region innervated by the ophthalmic nerve, and bruit on the left orbit. The mixed type of dural arteriovenous malformation (AVM) in the region of the cavernous sinus was diagnosed by MRI and cerebral angiography. The Matas procedure in which the patient was guided to compress the cervical carotid artery herself for 10 minutes three times a day was performed. Neurological signs and symptoms disappeared completely 3 months after starting the Matas procedure, and MRI revealed the regression of AVM. These results suggest that Matas procedure may promote its spontaneous regression of dural AVM occurred in the region of the cavernous sinus.     

Clinical study of spinal dural arteriovenous fistula-with special reference to neurological symptoms and magnetic resonance imaging]

We have evaluated the backgrounds, neurological symptoms, signs, and magnetic resonance images (MRI) in six cases of spinal dural arteriovenous fistula. The subjects were 2 males and 4 females, and the mean age was 67.2 years old. The cardinal subjective symptoms were progressive motor weakness of lower extremities (2 cases), paroxyomal weakness of lower extremities (3 cases), sensory disturbance of polyneuritic type (2 cases), and intermittent claudication (1 case). Administration of beverages and drugs, which might include vasodilators and taking baths, worsened the symptoms and signs in 3 cases and 2 cases respectively. Concerning to MRI findings, high signal intensities or swellings were observed at mid-thoracic area to upper conus of the spinal cord in all cases. These changes, which would be induced by edema caused by high venous pressure, were especially prominent in the central area of the cords. By these mechanisms, sensory disturbance like polyneuritic type caused by the disturbance in deep areas of posterior columns might more prominent than the disorder of spinothalamic tracts placed in superficial areas of cord in the early stage of the disease. These abnormal intensities of MRI were higher than the level of clinical symptoms and signs. The difference was about 6.5 segments. For this reason, the upper border of the spinal cord lesions could not be identified by the neurological symptoms. Although the clinical features and MRI findings are relatively characteristic, flow void signs by high resonance MRI and abnormal blood vessels by spinal angiography will be necessary to diagnose this disease confidently.     

Spinal subdural epidermoids - a separate entity: report of 3 cases

Intradural extramedullary epidermoid cysts are rare tumors especially those not associated with spinal dysraphism. We report 3 cases of spinal intradural extramedullary epidermoid cysts. In all the cases, the lesion was situated at dorsal level. The clinical features, MRI characteristics and surgical treatment of such rare intradural extramedullary benign tumors are discussed and relevant literature is reviewed.     

脊髓血管畸形的临床特征研究

目的:分析研究脊髓血管畸形的临床特征。方法:收集６２例ＭＲＩ、ＤＳＡ和(或)手术病理证实的脊髓血管畸形患者。结果;髓内隐匿型ＡＶＭ无明显的性别差异,余各类型男性多于女性;髓周ＡＶＭ、髓内ＡＶＦ青少年多见,硬膜型ＡＶＦ多见中老年;髓内ＡＶＭ多位于颈髓及胸腰髓,ＡＶＦ多位于胸腰段区域;髓内ＡＶＭ急性起病多见,ＡＶＦ多慢性起病,进行性加重。结论:根据临床症状、起病特征可初步判断病变类型,争取早期正确诊断、早期治疗。