摘要：

目的: 回顾性总结硬脊膜动静脉瘘的临床和影像学特征及预后。方法与结果: 纳入2019年5月至2024年1月天津市环湖医院诊断与治疗的17例硬脊膜动静脉瘘患者，15例以运动障碍、感觉障碍及自主神经功能障碍发病，2例以自发性蛛网膜下腔出血发病；病变位于胸椎12例，颈椎3例，腰骶椎2例；均行硬脊膜动静脉瘘切除术并顺利完成手术。术后随访(29.85±19.09)个月，术后7 d脊髓功能改善10例(步态评分改善6例、大小便功能评分改善1例、步态及大小便功能评分均改善3例)，无改善7例；末次随访时脊髓功能改善13例(步态评分改善8例、步态及大小便功能评分均改善5例)，无改善4例；随访期间无一例复发。结论: 硬脊膜动静脉瘘多发生于胸腰椎，症状呈进展性，以运动障碍、感觉障碍及括约肌功能障碍为主，少数以蛛网膜下腔出血首发，手术治疗失败率较低，效果明显，早期诊断可改善患者预后。

关键词: 脊髓, 动静脉瘘, 血管造影术, 显微外科手术, 预后

Abstract:

Objective: To review and analyze the clinical and imaging characteristics as well as the prognosis of patients with spinal dural arteriovenous fistula (SDAVF), in order to provide reference for the clinical diagnosis and treatment of SDAVF patients. Methods and Results: A total of 17 patients with SDAVF diagnosed and treated at Tianjin Huanhu Hospital from May 2019 to January 2024 were included in this study. Among them, 15 patients presented with motor dysfunction, sensory impairment and autonomic dysfunction, while 2 patients presented with spontaneous subarachnoid hemorrhage. The lesions were located in thoracic vertebra in 12 cases, cervical vertebra in 3 cases, and lumbosacral vertebra in 2 cases. All patients underwent surgical resection of the SDAVF, and the operations were successfully completed. The follow-up time was (29.85 ±19.09) months. At 7 d after surgery, the spinal cord function improved in 10 cases (including improvement in gait scores in 6 cases, bowel and bladder scores in one case, and both in 3 cases), while no improvement was observed in 7 cases. At the final follow-up, spinal cord function improved in 13 cases (including improvement in gait scores in 8 cases, and gait and bowel and bladder scores in 5 cases), while no improvement was observed in 4 cases. No recurrence was observed during the follow-up period. Conclusions: SDAVF predominantly occur in the thoracolumbar region of the spinal cord, with progressive symptoms mainly manifesting as motor dysfunction, sensory impairment and sphincter dysfunction. A small proportion of cases initially present with subarachnoid hemorrhage. The failure rate of surgical treatment is low, and the outcomes are significant. Early diagnosis can improve prognosis.

Key words: Spinal cord, Arteriovenous fistula, Angiography, Microsurgery, Prognosis