脊髄動静脈奇形の診断と治療

概要

論文の詳細を見る
Spinal arteriovenous malformation (spinal AVM) is a rare but clinically important disease in that it presents with progressive, somewhat stepwise worsening myelopathy, and its outcome of natural course is very poor. Classification of spinal AVM based on angiographical features has been very difficult to understand, and we propose here a comprehensive one based upon the sites of A-V shunts. For diagnostic purposes, MRI gives us not only the location of AVM but also the existence of venous congestion in the spinal cord itself. But selective spinal angiography still remains the gold standard for confirming the shunt points and planning the strategy of treatment. Both surgical and endovascular interventions are available for its treatment, and we detail all the surgical treatment procedures. The lateral oblique position reduces the risk of venous hypertension during surgery and is also comfortable for the operator. Using microdoppler monitoring with meticulous temporary clipping is somewhat laborious but the best method for understanding the complex vasculature as well as accurately implementing treatment. What is most essential is that the total extirpation of abnormal A-V shunts be realized for this disease to achieve total cure. The treatment strategy should be based on this point, and palliative therapy, which would produce a more complicated condition afterwards, should be avoided.
日本脳卒中の外科学会の論文
2004-01-31