硬脊膜动静脉瘘6例临床和影像学特点分析

目的 探讨硬脊膜动静脉瘘（spinal dural arteriovenous fistula，SDAVF）的临床和影像学特点，提高对于SDAVF的认识。方法 对6例确诊SDAVF患者的临床、影像学资料以及治疗与转归等进行回顾性分析。结果 6例患者中5例为中老年男性，1例为青年女性。6例患者的病灶部位均在胸腰段脊髓，其中3例有脊髓圆锥及马尾神经根受累。双下肢麻木症状发病3例，骶尾部或双下肢疼痛发病2例，下肢无力发病2例，6例患者均有尿便和性功能障碍，1例急性起病，5例亚急性或慢性起病。2例呈进行性病程，无明显波动，4例病程中病情有明显波动。脊髓磁共振检查（magnetic resonance imaging，MRI）全部病例均见到脊髓轻度增粗和髓内弥漫性长T2异常信号灶，4例脊髓表面尤其是背侧可见到迂曲血管流空影，腰骶段受累病例更加明显。6例均行脊髓数字减影血管造影（digital subtraction angiography，DSA）检查，见到供血动脉形成的动静脉瘘口以及明显蜿蜒迂曲延长的引流静脉从而确诊本病。全部6例患者的临床体征水平与影像学上病变水平均不甚一致，影像学表现重于临床。4例患者接受了1～3次的介入栓塞治疗，其中3例取得较好疗效，但这3例患者均有复发。结论 SDAVF有其临床和影像学特点。男性中老年患者多见，主要为胸段脊髓或腰骶段脊髓、神经根的症状体征，下肢感觉异常、疼痛、步态异常或运动障碍、尿便和性功能障碍均是常见的临床表现，可先后受累。病程可呈慢性进展，可在波动中进展，也可以进展中有波动。脊髓MRI检查对于本病的诊断可有提示。及早规范的血管栓塞或手术治疗可能取得较好疗效。

Clinical and Image Manifestations of Spinal Dural Arteriovenous Fistula: Six Cases Study

Objective To investigate the clinical and image feature of the spinal dural arteriovenous fistula （SDAVF） and to deepen the understanding of the disease. Methods Detailed clinical and image examinations were performed in all the 6 patients, who underwent spinal magnetic resonance imaging （MRI）, selective spinal digital subtraction angiography （DSA）. They all fulfilled the diagnostic criteria for the spinal dural arteriovenous fistula. Some of them accepted the therapy of embolism. Results Mean age was 49.3 years （27-65 years） and 5 were men. The spinal lesions were located in the segment of thorax and lumbar. Initial weakness and sensory changes were usually asymmetric （5 patients） and ascend from the lower extremities. Initial symptoms included leg sensory disturbances （3 patients）, pain involving hip and legs （2 patients）, leg weakness （2 patients）. Sphincter disturbances were presented in all of the 6 patients. Five patients presented subaeute or chronic period. Symptoms fluctuated in 4 of 6 patients. Spinal MRI showed the swelling and the abnormal signal in the spinal cord lesion. Persistent pathological vessels can be seen on MRI and be helpful for the diagnosis. DSA is the gold diagnostic standard for the disease when the dural arteriovenous fistula and arterialized draining vein are found. The sign level was not correlated wi~h the image level in the all cases. Four of 6 patients accepted therapy of embolism, 1 patient failed to improve and 3 patients demonstrated delayed deterioration after a oeriod of imlgrovement due to recurrentfistulas. Conclusion SDAVF had its clinical and image features. Neuroimaging was useful in confirming the diagnosis. Thus, the spinal should be examined with MR1 when a SDAVF is suspected. The therapy of embolism was relatively effective.