CAJ | 학술논문

目的探讨介入栓塞硬脊膜动静脉瘘(SDAVF)的可行性和有效性.方法自2010年12月至2012年5月共治疗104例SDAVF患者,选择符合条件的26例进行栓塞治疗.男性22例,女性4例,男女比例5.5:1；年龄34 ～81岁,平均55.9岁.SDAVF分别位于胸段10例、腰段9例、骶段7例.主要表现为双下肢进行性麻木无力和大小便障碍,病程1～ 156个月,平均17.1个月.栓塞材料使用ONYX-18液态栓塞剂或Glubran-2外科胶,未完全栓塞的患者,择期行手术治疗.治疗后3个月行脊髓功能评价和MRI检查,6个月行脊髓功能评价、MRI和脊髓血管造影检查.结果 26例患者中有15例达到即刻完全栓塞的影像学标准.使用ONYX-18栓塞20例,14例完全栓塞；应用Glubran-2栓塞6例,仅1例完全栓塞.10例胸段患者中仅3例获得完全栓塞,16例腰骶段患者中,12例完全栓塞.未完全栓塞的患者2周内均行手术治疗.所有病例于术后3和6个月复查MRI,6个月复查DSA.完全栓塞患者症状术后即刻均有不同程度的好转,6个月随访时肌力和大小便功能均有较明显的改善,MRI显示脊髓水肿消失,蛛网膜下腔的迂曲血管影消失.复查脊髓DSA均未见病变残留或复发.所有经过栓塞治疗的患者,术后未出现症状加重或新发症状.结论部分SDAVF,尤其病变位于腰骶部的患者,适宜栓塞治疗,栓塞的材料和方法需要进一步探讨.
목적 탐토개입전새경척막동정맥루(SDAVF)적가행성화유효성.방법 자2010년12월지2012년5월공치료104례SDAVF환자,선택부합조건적26례진행전새치료.남성22례,녀성4례,남녀비례5.5:1；년령34 ～81세,평균55.9세.SDAVF분별위우흉단10례、요단9례、저단7례.주요표현위쌍하지진행성마목무력화대소편장애,병정1～ 156개월,평균17.1개월.전새재료사용ONYX-18액태전새제혹Glubran-2외과효,미완전전새적환자,택기행수술치료.치료후3개월행척수공능평개화MRI검사,6개월행척수공능평개、MRI화척수혈관조영검사.결과 26례환자중유15례체도즉각완전전새적영상학표준.사용ONYX-18전새20례,14례완전전새；응용Glubran-2전새6례,부1례완전전새.10례흉단환자중부3례획득완전전새,16례요저단환자중,12례완전전새.미완전전새적환자2주내균행수술치료.소유병례우술후3화6개월복사MRI,6개월복사DSA.완전전새환자증상술후즉각균유불동정도적호전,6개월수방시기력화대소편공능균유교명현적개선,MRI현시척수수종소실,주망막하강적우곡혈관영소실.복사척수DSA균미견병변잔류혹복발.소유경과전새치료적환자,술후미출현증상가중혹신발증상.결론 부분SDAVF,우기병변위우요저부적환자,괄의전새치료,전새적재료화방법수요진일보탐토.
Objective To evaluate the feasibility and efficiency of embolization of spinal dural arteriovenous fistula (SDAVF).Methods From December 2010 to May 2012,there were 104 cases of SDAVF were treated,and 26 cases were selected to be treated with embolization.The inclusion criteria was as follows:(1) No anterior or posterior spinal artery originated from the fistula segment; (2) The segmental artery can be catheterized with guiding or micro catheter; (3) High flow in fistula; (4) Patient's situation was not suitable for surgery or general anesthesia.Among 26 cases,there were 22 male and 4 female patients,the average age was 55.9 years (ranged from 34 to 81 years).The locations of SDAVF were 10 cases in thoracic,9 in lumbar and 7 in sacral segment.The main symptoms were progressive numbness and weakness in both lower extremities,most cases accompanied with difficulties in urination and defecation.The average history was 17.1 months (from 1 to 156 months).ONYX-18 liquid embolic agent or Glubran-2surgical glue were used as embolic material.The patients not cured with embolization were treated with surgery in the following 1-2 weeks.Follow-up evaluation was done with MRI after 3 months and DSA after 6 months,besides physical examination.Results Fifteen from 26 cases achieved immediate angiographic cure results:14 in 20 cases which embolized with ONYX-18; only 1 in 6 cases with Glubran-2.Three in 10 cases of thoracic SDAVF and 12 in 16 cases of lumbar/sacral SDAVF were cured with embolization.Partially embolized cases were treated with surgical obliteration of drainage veins within 2 weeks.Cured patients experienced immediate improvement after embolization and kept getting better in the follow-up.All the patients had MRI follow-up after 3 months and DSA follow-up after 6 months.In 6 month's follow-up,MRI showed the edema and flow void signal in the spinal cord disappeared.DSA showed no fistula recurrence or remnant.There was no deterioration case in all of the embolized cases.Conclusions Particular SDAVF is suitable for embolization with ONYX-18.Most lesions located in lumbar and sacral segment are good indications for embolization.