脊髄硬膜動静脈瘻の臨床診断と治療

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Purpose : It is important to make a correct diagnosis of spinal dural arteriovenous fistulae (SDAVF) because the possibility of neurological improvements after correct treatment of this disease is strong. We studied the clinical characteristics of SDAVF. Materials & Methods : Between 1983 and 2001, 15 patients with SDAVF were surgically treated at our hospital. The 2 women and 13 men had a mean age of 59.8 years (range, 41-74 yr). At the time of their admission, five patients had a provisional diagnosis of intramedullary tumor, multiple sclerosis, or ossification of yellow ligament. The average duration of symptoms before the correct diagnosis was 24 months. All patients had motor weakness and sensory disturbance of lower extremities, which occurred insidiously in 11 patients or abruptly in 4 patients. Results : MRI scans were performed in 13 patients. T2-weighted MRI scans showed a diffuse high intensity area within the spinal cord in all patients examined. Swelling of the spinal cord was demonstrated in 85%, and gadolinium-enhanced areas were observed in 91%. The fistulae were located at the craniovertebral junction (1 case), thoracolumbar region (13 cases) and sacral portion (1 case). Three patients had multiple fistulae. Fistulae were coagulated and removed at the intradural and/or extradural areas. Symptoms improved in 9, remained unchanged in 5 and worsened in 1 patient after the treatment. Discussion and Conclusion : There may be several pitfalls in the diagnosis and treatment of this disease. Accurate knowledge of the clinical characteristics of this disease is essential for the correct diagnosis and treatment. In addition, a thorough angiographic study is also required because fistula may be located outside the thoracolumbar region and may be multiple.
日本脊髄外科学会の論文
2002-11-30

脊髄硬膜動静脈瘻の臨床診断と治療

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