CRANIAL AND SACRAL DURAL ARTERIOVENOUS-FISTULAS AS A CAUSE OF MYELOPATHY

被引:70
作者
PARTINGTON, MD
RUFENACHT, DA
MARSH, WR
PIEPGRAS, DG
机构
[1] MAYO CLIN & MAYO FDN,DEPT NEUROL SURG,ROCHESTER,MN 55905
[2] MAYO CLIN & MAYO GRAD SCH MED,DEPT NEUROL SURG,ROCHESTER,MN 55901
[3] MAYO CLIN & MAYO GRAD SCH MED,DEPT DIAGNOST RADIOL,ROCHESTER,MN 55901
关键词
ARTERIOVENOUS FISTULA; MYELOPATHY; VENOUS HYPERTENSION; SPINAL ARTERIOVENOUS MALFORMATION; SPINAL CORD;
D O I
10.3171/jns.1992.76.4.0615
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The authors report a series of seven patients with myelopathy who were found to have spinal dural arteriovenous (AV) fistulas in which the nidus was located at some distance from the spinal cord. The nidus was intracranial in three cases and involved a sacral nerve root sheath in the other four; in each case, the arterialized draining vein led into the coronal plexus of medullary veins. A lack of normal draining radicular veins was noted in all cases. Magnetic resonance images were obtained in four patients and demonstrated spinal cord tissue changes only in the lower thoracic cord in three cases and in the cervical cord in one, all consistent with an ischemic process secondary to venous hypertension. Five patients were managed surgically by division of the draining vein, with improvement of the neurological deficit in all. One patient was treated by embolization alone and had stabilization of her deficit. The remaining patient in the series died of unrelated systemic disease before the spinal dural AV fistula could be treated. These cases support the theory that venous hypertension is the dominant pathophysiological mechanism involved in spinal dural AV fistulas independent of their location. In patients with a suspected spinal dural AV fistula, lumbar and thoracic spinal angiography will reveal the site of the fistula in the majority of cases (88% in this series). In the remaining patients, the possibility of a remote fistula must be considered. The lack of normal venous drainage of the cord following injection in the artery of Adamkiewicz is the most reliable indicator of venous hypertension in the cord and can be helpful in making the decision to proceed with a search for a cranial or sacral arterial supply.
引用
收藏
页码:615 / 622
页数:8
相关论文
共 48 条
[11]  
Foix C, 1926, REV NEUROL PARIS, V33, P1
[12]   VEINS OF SPINAL CORD - ANATOMIC DETAILS - SUGGESTED CLINICAL APPLICATIONS [J].
GILLILAN, LA .
NEUROLOGY, 1970, 20 (09) :860-&
[13]   RECANALIZATION OF SPINAL ARTERIOVENOUS-MALFORMATIONS FOLLOWING EMBOLIZATION [J].
HALL, WA ;
OLDFIELD, EH ;
DOPPMAN, JL .
JOURNAL OF NEUROSURGERY, 1989, 70 (05) :714-720
[14]   HEMODYNAMICS OF SPINAL DURAL ARTERIOVENOUS-FISTULAS - AN INTRAOPERATIVE STUDY [J].
HASSLER, W ;
THRON, A ;
GROTE, EH .
JOURNAL OF NEUROSURGERY, 1989, 70 (03) :360-370
[15]   SPINAL ARTERIOVENOUS MALFORMATION WITH HYPOGASTRIC BLOOD-SUPPLY - CASE REPORT [J].
HEINDEL, CC ;
DUGGER, GS ;
GUINTO, FC .
JOURNAL OF NEUROSURGERY, 1975, 42 (04) :462-464
[16]  
HIRSCH NP, 1985, ANESTH ANALG, V64, P937
[17]   MAGNETIC-RESONANCE IMAGING IN CASES OF SPINAL DURAL ARTERIOVENOUS MALFORMATION [J].
ISU, T ;
IWASAKI, Y ;
AKINO, M ;
KOYANAGI, I ;
ABE, H .
NEUROSURGERY, 1989, 24 (06) :919-923
[18]   SPINAL EPIDURAL ANGIOMATOUS MALFORMATIONS DRAINING INTO INTRATHECAL VEINS [J].
KENDALL, BE ;
LOGUE, V .
NEURORADIOLOGY, 1977, 13 (04) :181-189
[19]  
LASJAUNIAS P, 1990, SURGICAL NEUROANGIOG, V3, P74
[20]   ANGIOMAS OF THE SPINAL-CORD - REVIEW OF THE PATHOGENESIS, CLINICAL FEATURES, AND RESULTS OF SURGERY [J].
LOGUE, V .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1979, 42 (01) :1-11