摘要
目的初步探讨复合手术在脊髓血管畸形治疗中的应用及其疗效。方法回顾性分析2019年11月至2023年6月郑州大学第一附属医院神经外科行复合手术[数字减影血管造影(DSA)联合显微外科手术]治疗的26例脊髓血管畸形患者的临床资料,其中硬脊膜动静脉瘘(SDAVF)11例,髓周动静脉瘘(PMAVF)11例,脊髓动静脉畸形(SAVM)4例。术中对PMAVF和SAVM患者进行神经电生理监测。通过门诊或住院等方式对患者进行随访,复查脊髓DSA;采用改良Aminoff-Logue残疾量表评分评估脊髓功能(评分下降≥1分为好转)。结果26例患者均按术前计划切除病变;15例患者术中神经电生理监测均未见波幅明显下降。11例SDAVF和10例PMAVF患者均为单一瘘口,术后即刻DSA结果均显示病变未显影,脊髓正常血管保留;1例多发瘘口PMAVF患者仅按术前计划切除导致症状的一处病变,术后即刻DSA显示该处病变未显影;4例SAVM患者的病变完全切除,术后即刻DSA结果显示畸形血管团未显影。术后2 d,25例患者的感觉障碍较术前改善,运动和括约肌功能无明显改善,另1例患者术后括约肌功能障碍加重。所有患者术后均无出血、感染等并发症。26例患者的术后随访时间[M(Q_(1),Q_(3))]为21(8,35)个月。至末次随访,26例患者的脊髓功能均好转,其中6例改良Aminoff-Logue残疾量表评分下降1分,11例下降2分,9例下降3分;复查DSA均未见手术部位脊髓血管畸形复发。结论初步观察发现,包括SDAVF、PMAVF和SAVM在内的脊髓血管畸形均可通过复合手术准确切除,且安全性较好,短期未见复发。
Objective To preliminarily explore the application and efficacy of hybrid surgery in the treatment of spinal cord vascular malformations.Methods A retrospective analysis was performed on the clinical data of 26 patients with spinal cord vascular malformations who underwent hybrid surgery[digital subtraction angiography(DSA)combined with microsurgery]at the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,from November 2019 to June 2023,including 11 cases of spinal dural arteriovenous fistulas(SDAVF),11 cases of peri-medullary arteriovenous fistula(PMAVF)and 4 cases of spinal arteriovenous malformation(SAVM).Neuroelectrophysiological monitoring was performed on patients with PMAVF and SAVM during surgery.The patients were followed up through outpatient or hospitalization,and spinal cord DSA examination was reviewed;the modified Aminoff-Logue disability score was used to evaluate spinal cord function(a score decrease of≥1 was considered improvement).Results All 26 patients had their lesions resected according to the preoperative plan.No significant decrease in amplitude was found in the intraoperative neuroelectrophysiological monitoring of 15 patients.Eleven cases of SDAVF and 10 cases of PMAVF all had a single fistula.The DSA results immediately after surgery showed that the lesion was not visualized and normal blood vessels in the spinal cord were preserved.In one case of PMAVF with multiple fistulas,only one lesion causing symptoms was removed according to the preoperative plan and immediate postoperative DSA showed that the lesion was not visualized.In 4 patients with SAVM,the lesions were completely removed,and the immediate postoperative DSA results showed that the malformed vascular mass was not visualized.On the 2nd day after surgery,the sensory impairment of 25 patients was improved compared with that before surgery,but the movement and sphincter function did not improve significantly.In another patient,sphincter dysfunction worsened after surgery.None of the patients had
作者
白亚辉
陈鑫璞
刘建新
王凯
郭社卫
刘献志
Bai Yahui;Chen Xinpu;Liu Jianxin;Wang Kai;Guo Shewei;Liu Xianzhi(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2024年第5期482-486,共5页
Chinese Journal of Neurosurgery
关键词
脊髓血管疾病
动静脉瘘
血管畸形
治疗结果
复合手术
Spinal cord vascular diseases
Arteriovenous fistula
Vascular malformations
Treat-ment outcome
Hybrid operation
