| Objective: The purpose of this study was to analyze whether hybrid operating room treatment of spinal cord vascular malformation can improve the quality of surgery,reduce the risk and improve the prognosis of patients,and the clinical value of intraoperative angiography in the diagnosis and treatment of spinal vascular malformation.Methods: This study retrospectively analyzed 20 patients with spinal cord vascular malformation treated by the Northern Theater General Hospital neurosurgery from March 2013 to January 2018.The clinical data of the patients were collected.All patients underwent magnetic resonance and spinal angiography before diagnosis.The hybrid operating room was used for the treatment.The spinal angiography was used to observe the vascular malformation dynamically,and the surgical effect was evaluated in time.The patients were followed up by outpatient,inpatient review and telephone contact for 6-12 months The modified Aminoff-Logue score was used to evaluate the spinal nerve function before and after surgery and statistical analysis was performed.Results: 11 patients(55%)with SDAVF completed complete occlusion of the fistula in the composite operating room.Two of them(18%)had multiple drainage vessels at the fistula,and the responsible blood vessels were determined by temporarily blocking and angiography,the normal drainage veins were reserved.Of the 7 patients(35%)with SAVM,5 patients(71%)with SAVM were completely resected by the hybrid operating room.2 patients(29%)had residual intraoperative spinal angiography for residual lesions.After careful exploration and separation,the complete resection of the malformed vascular group was confirmed by angiography again.2 patients(29%)underwent total resection of the SAVM.The patient had a small residual abnormal blood vessel in the spinal cord vascular DSA,and there was no obvious boundary with the spinal cord.Considering the protection of the spinal cord function,the residual part was not treated temporarily and was followed up closely.In 2 patients(10%)with PMAVF in the hybrid operating room,intraoperative spinal cord vascular DSA showed complete elimination of the fistula without residue.1 case(50%)was PMAVF located in the terminal silk.Intraoperative injection of Meilan into the contrast tube,clear the position of the fistula and then complete resection,and then the spinal cord vascular DSA showed sputum occlusion,abnormal vein disappeared.A total of 20 patients in this group were followed up for 6-12 months.No postoperative and angiographic complications were found.The symptoms of the patients were all improved,the muscle strength and sensation of the lower limbs were most obvious,and most of the urinary dysfunction was restored.Compared with the modified Aminofflogue scores of SDAVF patients,2 cases(18%)were cured,8 cases(73%)were improved,1 case(9%)was worsened,and the rate of improvement was 91%.SAVM patients improved Aminofflogue before and after operation.Scoring comparison showed that 2 cases(29%)were cured,4 cases(57%)were improved,1 case(14%)was unchanged,and the rate of improvement was 86%.The improvement of Aminofflogue score in patients with PMAVF before surgery was confirmed.For example(50%),1 case(50%)was improved and the improvement rate was 100%.All patients were cured in 5 cases(25%),13 cases(65%)improved,1 case(5%)without change,1 case(5%)worsened,and the improvement rate was 90%.The preoperative Aminofflogue score was 7.00(6.00,9.00)in SDAVF patients,and the modified Aminofflogue score was 3.00(2.00,4.00).The difference between preoperative and postoperative was statistically significant(P=0.03);SAVM patients improved Aminofflogue score For the 7.00(4.00,8.00),the postoperative modified Aminofflogue score was 3.00(1.00,4.00),the difference between the preoperative and postoperative differences was statistically significant(P = 0.016);the preoperative modified Aminofflogue score of PMAVF patients was 7.00(6.00,-),the postoperative modified Aminofflogue score was 3.50(2.00,-).There was no significant difference between preoperative and postoperative(P=0.18).The total Aminofflogue score was 6.00(5.00,7.75).The post-modified Aminofflogue score was 3.00(2.00,4.00),and the difference between the preoperative and postoperative was statistically significant(P=0.01).Conclusion:1.The treatment of spinal cord vascular malformation in the hybrid operating room has achieved good clinical results,improved the prognosis of patients,reduced the risk of intraoperative,and provided a new idea for the realization of clinical first-stage treatment.2.The application of intraoperative angiography can accurately locate the location of the fistula and malformed vascular mass,clarify the running and number of blood supply arteries,reduce the leakage of the clip,the incomplete closure of the fistula,the incomplete resection of the malformation,etc.and ensure that the surrounding normal blood vessels are not damaged.Provide a clinical basis for the surgeon to develop a correct surgical strategy... |
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