| Objective:Spinal dural arteriovenous fistulas were firstly described and reported by Kendall in1970s, which are defined as abnormal arteriovenous shunts within the dura adjacent tointervertebral foramen supplied by the dural or nerve root arteries and drained by theperimedullary veins.SDAVFs are the most common type of vascular malformations of the spine, whichconstitute approximately70%of all spinal AVMs. In1926, Foix and Alajouanine firstlydescribed the pathological type in terminal stage of the spinal cord injury caused by SDAVFs.They regarded it as subacute necrotizing myelitis. The basis of vessel pathology was clearlyacquainted by Kendall and Logue until50years later. They considered that SDVAFs weretiny vessel fistula(about140μm) within spinal dura adjacent to intervertebral foramen andcaused a series of abnormality.Although the exact pathogenesis of SDAVFs is not clear, more and more scholarsconsidered that the formation is caused by acquired factors. The spinal dysfunction is mainlycaused by the hypertension of spinal vein, ischemia, edema, demyelination and necrosis.Besides, movement, lumbar puncture, DSA, and injury could exacerbate the symptoms.Most patienets will turn into the irreversible stage as paralysis within the natural course of3to5years, so it is essential to occlude the shunting zone from the fistula and minimize theduration of spinal cord venous hepertension and reduce the likehood of permanentparaparesis, which can lead to improvement of symptoms.The initial symptoms of SDAVFs are nonspecific and always attack invisibly. Therefore,it is indispensable to make an early diagnosis and treatment. With the development ofdiagnosis technique, such as MRI, CTA and DSA, the relevance ratio of SDAVF isincreasing by years. There are two options in the treatment of SDAVFs: surgical occlusion orendovascular embolization. With the rapid development of interventional neuroradiology andmicroneurosurgery, scholars have made further acknowledgement with SDAVFs to improvethe diagnosis and treatment methods. From Jan.2011to Mar.2014,7SDAVFs patients had been examined by DSA andtreated by surgical occulsion in the Neurovascular Department of the1st Hospital of JilinUniversity. We analyzed retrospectively with these cases to discuss the diagnosis, treatmentand clinical research progress of SDAVFs.Purposes:To analyze the clinical and imaging features, discuss the methods of diagnosis andtreatment, made further acknowledgement with SDAVFs to improve the diagnosis andtreatment level.Datas and Methods:Retrospective analyzing clinical data of7SDAVFs cases, all the patients accepted MRIand DSA to locate the fistula sites and then accepted surgical occlusion to block the bloodfrom the shunt zone or feeding arterya. Anticoagulation treatment was performed afteroperation.Results:All the patients’ symptoms were improved especially the alleviation of ache and numbof lower limb, the bowel and bladder function were improved also. The follow-up intervalwas3to24months in7cases. According to the modified Amilnoff-Logue scale:6caseswere improved(85.7%),1case was unchanged(14.3%), no exacerbation.2cases whichimproved in the gait and muscle strength of lower limb by1point(28.6%),3cases by2points(42.9%), while1case unchanged(14.3%).2cases improved in the defecation functionby2points(28.6%). All the patients above did not recur during the peroid of follow-up.Conclusion:SDAVFs usually occur in meddle-aged men. The patients usually present with chronicprogressive myelopathy, such as sensory and motor deficits, bowel and bladder dysfunction.We could give a primary diagnosis by spinal MRI. DSA is the diagnosis standard and couldhelp us to locate the fistula accurately. There are two options for treatment of SDAVF:surgical occlusion or endovascular embolization. It is indispensable to make an earlydiagnosis and treatment to improve the clinical symptoms. |
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