摘要
目的探讨荧光造影技术在脊髓硬脊膜动静脉瘘(DAVF)显微手术中的应用价值。方法回顾性分析四川大学华西医院神经外科2012年1月—2018年1月收治的28例脊髓硬脊膜动静脉瘘患者的资料。患者均行脊髓血管造影确诊。手术采用全椎或半椎板入路,术中用吲哚菁绿荧光造影明确瘘口的位置、引流静脉及供血动脉,行瘘口切除后再次造影检查。采用改良Aminoff-Logue量表(ALS)评估患者手术前后的脊髓功能。结果本组患者中瘘口位于颅颈交界、胸髓上段、胸髓下段、脊髓腰段的患者,分别为2例、8例、10例、8例。患者手术均成功,瘘口均完全切除,术后影像学复查无复发者。随访时间6~72个月,结果显示治愈为18例、改善8例、无变化2例,好转率为92.85%。患者术后的改良ALS评分(2.1±1.4)比术前(4.6±1.9)明显好转(P<0.05)。结论显微外科手术是治疗脊髓硬脊膜动静脉瘘最有效的方法。术中采用荧光造影,能准确定位瘘口位置,同时对瘘口切除进行评估,极大地提高了手术的精准度。
Objective To investigate the value of fluorescein angiography during microsurgery for spinal dural arteriovenous fistulas(DAVF).Methods The clinical data of 28 patients with spinal DAVF admitted at Department of Neurosurgery,West China Hospital,Sichuan University from January 2012 to January 2018,were analyzed retrospectively.The fistulas were diagnosed by spinal angiography.During surgery,the location of the fistula,drainage vein and supplying artery were determined by fluorescence angiography,and the fluorescence angiography was repeated after the occlusion of the fistulas.The spinal cord function before and after the operation was evaluated using the modified Aminoff-Logue scoring(ALS)system.Results The fistulas were found in the craniocervical junction in 2 cases,in the upper thoracic in 8,in the lower thoracic in 10,and in the lumbar spine in 8.The operation was successful and the fistulas were completely removed.There was no recurrence or omission in postoperative angiographic examination.The mean follow-up time was 6-72 months.The follow-up outcomes showed that 18 cases were cured,8 improved and 2 unchanged.The improvement rate was 92.85%,and the modified ALS after operation was(2.1±1.4)points,which was significantly better than that before operation(P<0.05).Conclusions Microsurgery intervention is an effective method for the treatment of spinal DAVF.Fluorescein angiography can locate the fistula point accurately and demonstrate the occlusion of the fistula,which significantly improved the surgical accuracy.
作者
胡智洪
游国亮
何敏
李伟
杨启荣
罗川东
李进
HU Zhi-hong;YOU Guo-liang;HE Min(Department of Neurosurgery,The People's Hospital of Leshan City Central District,Leshan 614000,China)
出处
《临床神经外科杂志》
CAS
2020年第4期396-398,404,共4页
Journal of Clinical Neurosurgery
基金
国家自然科学基金(81571131)。
关键词
荧光造影
显微外科手术
脊髓硬脊膜动静脉瘘
fluorescein angiography
microsurgery
spinal dural arteriovenous fistulas
