颈髓髓内动静脉畸形的治疗(附5例报告)

目的:观察显微手术切除和血管内栓塞治疗颈部脊髓髓内动静脉畸形的效果。方法:本文收集了1993～2000年收治的5例脊髓髓内的动静脉畸形,男性2例,女性3例,年龄16～43岁,平均30.8岁,均由血管造影所证实,2例予显微手术切除,3例行血管内治疗。结果:治疗后均予再次造影,显示2例动静脉畸形全切除,2例血管畸形基本栓塞,1例大部栓塞。经6月～2年的随访患者均无临床症状加重的表现,且部分神经功能缓解。结论:对颈部脊髓髓内动静脉畸形应积极治疗,根据不同情况选择显微外科手术或血管内治疗,可帮助部分神经功能的恢复,防止病情继续恶性化。     

脊髓血管胚胎发育的研究对脊髓血管畸形治疗的指导

目的 探讨脊髓血管胚胎发育对脊髓动静脉畸形治疗的指导意义。方法 采用各胎龄胚胎及胎儿、新生儿和成人尸体标本，观察脊髓血管。回顾324例脊髓血管畸形的诊治。结果 描述对脊髓血管胚胎各期的发育特征，分析脊髓纵裂畸形和椎体血管瘤伴发的脊髓动静脉畸形病例。在髓内动静脉畸形的手术中发现畸形团与正常脊髓实质之间有一层增生的胶状质相隔。结论 脊髓血管最早发生在脊髓表面，逐渐长入或被卷入脊髓实质。脊髓动静脉畸形最早发生在胎龄3周以前。大部分脊髓动静脉畸形团可以切除，而不损伤脊髓。     

吲哚菁绿术中荧光造影辅助下脊髓血管畸形的手术治疗

目的 总结吲哚菁绿术中荧光造影辅助下脊髓血管畸形的手术疗效.方法 自2009年8月至2011年5月,共收治脊髓血管畸形24例,在吲哚菁绿术中荧光造影辅助下行手术切除畸形血管团或夹闭畸形血管瘘口,对其疗效进行随访.结果 除1例外,术中荧光造影确认瘘口完全夹闭或髓内畸形血管团完全切除.脊髓正常血供和静脉回流得以满意保留.21例获得随访,术后3例失访.其中痊愈6例,改善10例,稳定2例,加重3例.结论 吲哚菁绿术中荧光造影可以有效地提高脊髓血管畸形的手术疗效.     

脊髓血管畸形(附70例分析)

目的探讨脊髓血管畸形的临床特征、诊断及治疗方法.方法回顾性分析70例经MRI、DSA和(或)手术病理证实的脊髓血管畸形病例,其中髓内血管畸形38例,髓周动静脉瘘21例,硬脊膜动静脉瘘11例.结果单纯性栓塞治疗24例,先栓塞后手术5例,单纯手术治疗39例,保守治疗2例.随访56例,痊愈12例,好转29例,无变化11例,恶化4例.结论MRI与DSA结合是诊断脊髓血管畸形的最好手段.针对不同病变特点和影像特征,选择恰当的治疗方法是成功的关键.     

头皮血管畸形的外科治疗

目的：讨论有关头皮血管畸形的诊断和治疗问题。方法：３２例头皮血管畸形经显微手术全切除。年龄６～５９岁，１４岁以下儿童１１例，平均年龄２８．４岁。畸形血管直径３～５ｃｍ１１例，５～１０ｃｍ１８例，大于１０ｃｍ３例。结果：经病理证实毛细血管畸形１例，海绵状血管瘤４例，动静脉畸形２７例。３２例随访１２～４０月，平均１８月，未见复发。结论：头皮血管畸形属先天畸形，但也可能与头部外伤有关，本组４例有头部外伤史。本病以手术切除最为彻底。脑血管造影是确诊的重要手段。单纯颞浅动脉供血属普通型。脑膜中动脉和颈内动脉参与供血属复杂型。     

脊髓血管畸形的外科治疗

脊髓血管畸形应早期在外科显微镜下,使用双极电凝完全切除,不应等到严重截瘫才行手术。本文报告8例脊髓血管畸形,其中1例并发放射性脊髓肉芽肿,1例并发髓内动脉瘤,2例合并蛛网膜炎,2例合并脊髓严重萎缩。全部进行了脊髓造影,3例进行了选择性脊髓血管造影。血管畸形,肉芽肿及动脉瘤皆全部切除。术后显效3例,改善3例,微效2例。本文详细讨论了手术疗效、术前诊断和手术方法,并认为放射治疗对脊髓血管畸形无益而有害。     

脊髓血管母细胞瘤的显微外科治疗

目的 探讨脊髓血管母细胞瘤的显微外科治疗方法.方法 回顾性分析16例脊髓血管母细胞瘤病人的临床资料.术前均行血管造影,其中完全栓塞或部分栓塞9例.术中采用吲哚菁绿血管造影再次确认相关血管,采用显微外科手术切除肿瘤.结果 16例脊髓血管母细胞瘤均全切除.术后随访3个月,根据McCormick脊髓功能状态分级:明显改善12例,无变化3例,加重1例.结论 脊髓血管母细胞瘤通过显微外科手术切除可以取得良好疗效,术前血管造影栓塞和术中荧光血管造影有利于减少术中出血,提高手术安全性.     

脊髓圆锥部的髓内动静脉畸形并发同侧腰骶部的动静脉瘘

目的增强临床医师对脊髓圆锥部的髓内动静脉畸形(SAVM)并发同侧腰骶部的动静脉瘘(硬脊膜动静脉瘘和髓周动静脉瘘)的认识。方法回顾性统计分析4年来北京宣武医院共收治的6例圆锥部的SAVM并发同侧腰骶部的动静脉瘘的患者,分析其临床与影像学特征、治疗方式及预后转归。结果所有患者均在全脊髓血管造影后得到确诊。单纯手术治疗3例,先栓塞后手术1例,先手术后栓塞2例,术后症状全部改善。6例随访,未见症状加重及复发。结论早期发现、正确诊断、早期治疗是成功的关健。从头颈到骶椎完整的全脊髓造影对诊断至关重要。治疗的关键是既要完整去除圆锥部的畸形又要切断硬脊膜的血管,如硬脊膜支或根动脉对瘘口的供血,而保留正常的脊髓静脉引流。     

显微手术联合术中血管造影治疗硬脊膜动静脉瘘

目的 探讨显微手术联合术中脊髓血管造影检查治疗脊髓硬脊膜动静脉瘘的疗效和应用价值。方法 回顾性分析四川大学华西医院神经外科2013年5月—2017年9月,采用显微手术闭塞瘘口同时行术中脊髓血管造影检查治疗的52例脊髓硬脊膜动静脉瘘患者的临床资料。结果 在术中脊髓血管造影辅助下,52例患者术中达到100%的解剖治愈率。术后第7 d 43例患者(82. 7%)的脊髓功能评分改善。术后50例患者(96. 2%)随访6个月,Aminoff评分显示28例患者(56%)治愈,18例患者(36%)脊髓功能改善,4例患者(8%)脊髓功能无变化;无症状加重者。结论 显微手术闭塞瘘口能有效治疗脊髓硬脊膜动静脉瘘,术中脊髓血管造影对准确判断是否完全闭塞瘘口和多个瘘口的存在有着极大地帮助。     

髓内型海绵状血管畸形的临床研究(附15例报告)

脊髓海绵状血管畸形在临床上比较少见,国外报道也不多[1～3],单纯的脊髓髓内海绵状血管畸形(intramedullary spinalcord cavernous malformation,ISCC)就更少。随着MRI的广泛应用,此病例的报告不断增加。而显微神经外科手术技术的开展使得该病的治疗效果有了极大改善[4～6]。我科自2008年9月至2011年12月共收治15例脊髓髓内海绵状血管畸形患     

脊髓血管畸形合并胸腔血管畸形

脊髓血管畸形的临床发病率较低,仅为颅内血管畸形或脊髓新生物的1/10左右.本病可能与其它组织的血管异常同时存在,如皮肤血管痣(Cobb综合征),皮肤、粘膜病变,和Klipple-Trenaunay-Weber综合征等.本文报告的与胸腔血管畸形同时存在的脊髓血管畸形,我们尚未见诸报道.本文还结合文献就脊髓血管畸形导致脊髓功能损害的病理生理作了阐述.     

Arteriovenous malformation of the spinal cord in the neonate

A newborn baby boy with a high-flow arteriovenous malformation (AVM) of the dorsal spinal cord is reported. The baby was born paraplegic. The myelogram suggested an increased vasculature, showing irregular worm-like radiolucent lesions of the dorsal spinal cord. Spinal angiography showed a huge arteriovenous angioma of the dorsal spinal cord with an intra-spinal aneurysmal sac. The vascular supply was decreased after two embolizations. This was followed by complete surgical resection of the aneurysmal sac.     

Intracranial dural arteriovenous fistula with spinal venous drainage]

Two cases of intracranial dural arteriovenous fistulae draining into the medullary veins are reported. One patient was a 68-year old man who experienced brief and repeated episodes of paraplegia, followed by a permanent spinal cord syndrome. The other patient was a 74-year-old woman who rapidly developed a syndrome of the medulla and spinal cord. In both cases spinal cord angiography failed to show vascular malformations, but myelography revealed venous imprints and magnetic resonance imaging of the cervical spinal cord disclosed a pre-medullary signal. Cerebral angiography showed an intracranial arteriovenous fistula fed by the external carotid artery and draining into the veins of the posterior fossa and the spinal venous network. Complete occlusion of the fistula was achieved by embolization with microparticles. Intracranial dural arteriovenous fistulae draining into the medullary veins are rare: to our knowledge, only 4 cases have been reported. Such lesions must be considered whenever a spinal cord syndrome has no detectable cause.     

CT in the diagnosis of cerebral vascular malformations

Summary In 72 patients with spontaneous intracranial haemorrhage and vascular malformation, 27 of 49 arterial aneurysms were diagnosed by CT (the smallest one of 4 mm diameter being stalked), as were all (18) of the arteriovenous aneurysms (angiomas), but of the venous malformations (5) only 2 (aneurysms of the vein of Galen) were so diagnosed. In the 25 patients with spontaneous subarachnoid haemorrhage, in whom vascular malformation had not been diagnosed through angiography or CT, CT showed the position and extent of the parenchymatous lesion or the existence of blood in the subarachnoid space or ventricules. Finally, in 15 patients with subjective or neuropsychiatric disturbances, 9 arterial and 6 arteriovenous aneurysms were diagnosed by CT and were verified by angiography, which would probably not have been performed if CT had not been performed. Thus it is clear that vascular malformations are often diagnosed by CT. In many cases information is revealed which would not be suspected with angiography, while in other cases angiography is more selective and accurate.     

建立椎管内静脉高压动物模型的手术方法及稳定性评价*

背景：构建稳定的脊髓静脉高压动物模型可为临床研究脊髓血管病变提供可靠的平台,课题组前期已成功构建了兔脊髓静脉高压模型。 目的：在前期研究基础上改进手术方法和围手术期处理,建立长期稳定的兔脊髓静脉高压模型。 方法：48只新西兰大白兔随机分为急性期组、短期组、中期组、长期组,每组12只兔又分为模型兔8只和假手术兔4只。模型兔通过开腹侧侧吻合兔左肾动静脉,形成动静脉瘘,结扎后腔静脉远端和近端导致动脉血异常引流至腰静脉、椎管内静脉丛形成脊髓淤血和脊髓静脉高压。采用Jacobs法对后肢功能评级,Reuter法评估脊髓感觉运动反射功能,每组动物到期后对模型兔行MRI扫描、经股动脉DSA检查动静脉瘘口的通畅,并灌注解剖取脊髓行病理学检查以判定模型符合要求。 结果与结论：32只模型兔存活29只,生存率91%,动静脉瘘口通畅率79%,但长期组瘘口通畅率低,仅29%。术后模型后肢运动、感觉功能均有所减退。模型兔脊髓MRI表现为脊髓相应阶段的水肿;病理检查在光镜下见脊髓实质内淋巴细胞的浸润、胶质细胞的增生、髓内血管的玻璃样变性和神经元细胞变性,符合脊髓静脉高压的脊髓病理变化;透射电镜观察可见髓鞘板层的松散、薄髓纤维内线粒体数目增加和神经元的固缩。提示成功建立模拟人类脊髓血管畸形的脊髓静脉高压机制导致脊髓损伤的动物模型,该模型的可靠性和稳定性较高。     

Vertebro-epidural lumbosacral vascular malformations. An unusual cause of lumbo-sciatic pain

Sciatica is most commonly caused by nerve root compression secondary to herniated disk. Rarely, it can be due to a lumbosacral vascular malformation. We present five cases with such a malformation, presenting as a chronic lumboradiculagia. The patients were explored with computed tomography, MRI and selective spinal angiography. Polymorphic anatomic and hemodynamic aspect of these cases are reported: 1. One vertebral hemangioma with epidural extension; 2. Three purely epidural malformations: a) one epidural cavernous hemangioma, b) one epidural arteriovenous malformation, c) one epidural varix; 3. One paravertebral arteriovenous fistula with epidural venous drainage. Diagnosis of these rare malformations may be difficult. A multiplanar cross-sectional magnetic resonance and computed tomography scan with contrast enhancement can show characteristic abnormalities and may assist in recognition these malformations. Selective spinal angiography confirms the diagnosis, allows to classify the malformation and is required to evaluate endovascular therapeutic possibilities.     

脊髓硬脊膜动静脉瘘的临床特点(附2例报道和222例文献分析)

目的探讨脊髓硬脊膜动静脉瘘的发病机制和临床特征,以增进对该病的认识,减少误诊误治。方法报道2例临床病例,附1例手术和病理所见。结合文献中222例报道,进行临床分析。结果脊髓硬脊膜动静脉瘘是脊髓动静脉性血管病变的一种类型,临床表现为进行性、上行性的双下肢运动、感觉、大小便功能障碍,由于该病早期的症状和体征无特异性,易造成误诊,脊髓MRI和脊髓血管造影有特征性表现。结论对急性、亚急性病程的脊髓病变患者的MRI图像认真分析,并进行选择性脊髓血管造影检查,有利于早期确诊本病。早期诊断、早期治疗可以较好地改善临床症状。     

Ruptured aneurysm of the posterior spinal artery of the conus medullaris.

A case of a posterior spinal artery aneurysm of the conus medullaris is presented. The patient presented with severe lower back pain with radiation into the right leg. Spinal angiography was consistent with a partially thrombosed arteriovenous malformation (AVM) or an aneurysm. At operation a partially thrombosed aneurysm of the posterior spinal artery was found at the level of conus medullaris, which, after review of the literature, is the first case treated with total microsurgical excision.