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胸椎区域硬脊膜动静脉瘘1例并文献回顾
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Abstract:
目的：探讨胸腰椎区域硬脊膜动静脉瘘(Spinal dural arteriovenous fistula, SDAVF)的发病机制、临床表现和治疗。方法：回顾1例胸椎区域SDAVF患者的诊治过程并进行文献回顾。结果：患者为55岁男性，以腰痛伴左下肢麻木为首发症状，随后出现行走困难，脊柱MRI的T2加权序列中显示脊髓高信号和髓周空流血管影，脊髓血管造影术确诊胸椎区域硬脊膜动静脉瘘。结论：SDAVF较为罕见，误诊率较高，晚期诊断容易使患者预后恶化，因此，及早的诊断与干预变得尤为关键。
Objective: To investigate the pathogenesis, clinical manifestations, and treatment of spinal dural arteriovenous fistula (SDAVF) in the thoracolumbar region. Method: A retrospective review of the diagnosis and treatment process of a patient with thoracic spinal dural arteriovenous fistula (SDAVF) and a literature review. Results: The patient, a 55-year-old male, presented with initial symptoms of lower back pain accompanied by numbness in the left lower limb, followed by walking difficulties. In the T2-weighted sequence of the spinal MRI, high signal intensity in the spinal cord and a vascular flow void around the spinal cord were observed. The diagnosis of spinal dural arteriovenous fistula in the thoracic region was confirmed by spinal cord vascular angiography. Conclusion: SDAVF is relatively rare, with a high misdiagnosis rate. Late diagnosis can easily lead to worsening prognosis for patients. Therefore, early diagnosis and intervention are particularly critical.
| [1] | Lizana, J., Aliaga, N., Marani, W., Escribano, A. and Montemurro, N. (2022) Spinal Vascular Shunts: Single-Center Series and Review of the Literature of Their Classification. Neurology International, 14, 581-599. https://doi.org/10.3390/neurolint14030047 |
| [2] | Takai, K. (2017) Spinal Arteriovenous Shunts: Angioarchitecture and Historical Changes in Classification. Neurologia Medico-chirurgica, 57, 356-365. https://doi.org/10.2176/nmc.ra.2016-0316 |
| [3] | Kiyosue, H., Matsumaru, Y., Niimi, Y., Takai, K., Ishiguro, T., Hiramatsu, M., et al. (2017) Angiographic and Clinical Characteristics of Thoracolumbar Spinal Epidural and Dural Arteriovenous Fistulas. Stroke, 48, 3215-3222. https://doi.org/10.1161/strokeaha.117.019131 |
| [4] | Takai, K. and Taniguchi, M. (2019) Clinical and Neuroimaging Findings of Spinal Dural Arteriovenous Fistulas: How to Avoid Misdiagnosis of This Disease. Journal of Orthopaedic Science, 24, 1027-1032. https://doi.org/10.1016/j.jos.2019.07.014 |
| [5] | Cenzato, M., Debernardi, A., Stefini, R., D’Aliberti, G., Piparo, M., Talamonti, G., et al. (2012) Spinal Dural Arteriovenous Fistulas: Outcome and Prognostic Factors. Neurosurgical Focus, 32, E11. https://doi.org/10.3171/2012.2.focus1218 |
| [6] | Msheik, A., Al Mokdad, Z., Gerges, T. and Aoude, A. (2023) Spinal Dural Arteriovenous Fistula: Insights into Operative Management. Cureus, 15, e38448. https://doi.org/10.7759/cureus.38448 |
| [7] | Rashad, S., Abdel-Bary, M., Aziz, W. and Hassan, T. (2014) Management of Spinal Dural Arterio-Venous Fistulas. Report of 12 Cases and Review of Literature. Clinical Neurology and Neurosurgery, 125, 81-86. https://doi.org/10.1016/j.clineuro.2014.07.028 |
| [8] | Wang, P., Zhang, L., Zhang, W., Shi, T., Sun, Y., Cui, S., et al. (2023) Dural Arteriovenous Fistula with Spinal Dural Arteriovenous Fistula: A Case Report and Review of the Literature. Journal of Medical Case Reports, 17, Article No. 467. https://doi.org/10.1186/s13256-023-04170-y |
| [9] | Yunga Tigre, J., Costello, M.C., Maddy, K., Errante, E.L., Berger, C.C. and Burks, S.S. (2023) Surgical Management of a Spinal Dural Arteriovenous Fistula. Cureus, 15, e36533. https://doi.org/10.7759/cureus.36533 |
| [10] | Sucuoğlu, H. (2020) Spinal Dural Arteriovenous Fistula: A Rare Cause of Progressive Myelopathy and Bladder and Bowel Dysfunction. Turkish Journal of Physical Medicine and Rehabilitation, 66, 219-222. https://doi.org/10.5606/tftrd.2020.3732 |
| [11] | Ronald, A.A., Yao, B., Winkelman, R.D., Piraino, D., Masaryk, T.J. and Krishnaney, A.A. (2020) Spinal Dural Arteriovenous Fistula: Diagnosis, Outcomes, and Prognostic Factors. World Neurosurgery, 144, e306-e315. https://doi.org/10.1016/j.wneu.2020.08.126 |
| [12] | Mansour, M.A., Khalil, D.F., El-Sokkary, S., Mostafa, M.A. and Ayad, A.A. (2023) Spinal Dural Arteriovenous Fistula Masquerading as a Herniated Disc: Illustrative Case. Journal of Neurosurgery: Case Lessons, 5, CASE22567. https://doi.org/10.3171/case22567 |
| [13] | Ma, Y., Hong, T., Chen, S., Peng, C., Wang, C., Yang, K., et al. (2020) Steroid-associated Acute Clinical Worsening and Poor Outcome in Patients with Spinal Dural Arteriovenous Fistulas: A Prospective Cohort Study. Spine, 45, E656-E662. https://doi.org/10.1097/brs.0000000000003370 |
| [14] | Khalafallah, A.M., Yunga Tigre, J., Rady, N., Starke, R.M., Saraf-Lavi, E. and Levi, A.D. (2024) Evaluating the Diagnostic Accuracy of 3D Contrast-Enhanced Magnetic Resonance Angiography versus Digital Subtraction Angiography in Spinal Dural Arteriovenous Fistulas. Neurosurgical Focus, 56, E10. https://doi.org/10.3171/2023.12.focus23749 |
| [15] | Albader, F., Serratrice, N., Farah, K. and Fuentes, S. (2022) Minimally Invasive Microsurgical Treatment of Spinal Dural Arteriovenous Fistula: How I Do It. Acta Neurochirurgica, 164, 1669-1673. https://doi.org/10.1007/s00701-022-05200-2 |
| [16] | Wojciechowski, J., Kunert, P., Nowak, A., Dziedzic, T., Czernicki, T., Wójtowicz, K., et al. (2017) Surgical Treatment for Spinal Dural Arteriovenous Fistulas: Outcome, Complications and Prognostic Factors. Neurologia i Neurochirurgia Polska, 51, 446-453. https://doi.org/10.1016/j.pjnns.2017.07.001 |
| [17] | Goyal, A., Cesare, J., Lu, V.M., Alvi, M.A., Kerezoudis, P., Brinjikji, W., et al. (2019) Outcomes Following Surgical versus Endovascular Treatment of Spinal Dural Arteriovenous Fistula: A Systematic Review and Meta-Analysis. Journal of Neurology, Neurosurgery & Psychiatry, 90, 1139-1146. https://doi.org/10.1136/jnnp-2019-320648 |
| [18] | Vercelli, G.G., Minardi, M., Bergui, M., Zenga, F., Garbossa, D. and Cofano, F. (2023) Spinal Dural and Epidural Arteriovenous Fistula: Recurrence Rate after Surgical and Endovascular Treatment. Frontiers in Surgery, 10, Article ID: 1148968. https://doi.org/10.3389/fsurg.2023.1148968 |
| [19] | Alkhaibary, A., Alharbi, A., Alnefaie, N., Alammar, H., Arishy, A.M., Alghanim, N., et al. (2024) Spinal Dural Arteriovenous Fistula: A Comprehensive Review of the History, Classification Systems, Management, and Prognosis. Chinese Neurosurgical Journal, 10, Article No. 2. https://doi.org/10.1186/s41016-023-00355-y |
