骶段硬脊膜动静脉瘘多瘘口1例报告并文献复习

Sacral Dural Arteriovenous Fistula with Multiple Fistulas: A Case Report and Literature Review

摘要: 目的：探讨多瘘口骶段硬脊膜动静脉瘘的临床特点，诊断与治疗。方法：结合本院多瘘口骶段硬脊膜动静脉瘘病例，参考国内外文献，处理并分析此类疾病患者的临床症状及表现、体征、腰骶椎MR表现、脊髓血管造影表现、手术方法及预后。结果：患者因“右下肢麻木9月余，加重3月”入院，胸腰椎磁共振检查显示胸髓及腰椎管增粗、脊髓腹侧大量流空影；脊髓血管造影检查显示骶3、骶5水平各有一处瘘口。术后病理脂肪瘤伴血管畸形。结论：骶段多瘘口硬脊膜动静脉瘘病例较为罕见，早期症状不明显且易漏诊，磁共振检查对此病诊断有一定的参考意义，脊髓血管造影术是此病诊断的金标准，首选的治疗措施是外科显微镜下阻断瘘口治疗。

Abstract: Objective: To investigate the clinical characteristics, diagnosis and treatment of sacral dural arteriovenous fistula with multiple fistulas. Methods: Combined with the cases of multiple fistula sacral dural arteriovenous fistula in our hospital, referring to the domestic and foreign literature, the clinical symptoms and manifestations, physical signs, lumbosacral MR manifestations, spinal cord angiography manifestations, surgical methods and prognosis of patients with this kind of disease were analyzed. Results: The patient was hospitalized because of “numbness of right lower limb for more than 9 months, aggravating for 3 months”. MRI examination of thoracolumbar spine showed that the thoracic spinal cord and lumbar spinal canal were thickened, and a large number of empty shadows were found in the ventral side of spinal cord; spinal angiography showed that there was a fistula at the level of sacral 3 and sacral 5. Postoperative pathological was lipoma with vascular malformation. Conclusion: The cases of sacral multi fistula dural arteriovenous fistula are rare; the early symptoms are not obvious and easy to miss diagnosis. Magnetic resonance examination has a certain reference significance for the diagnosis of this disease. Spinal cord angiography is the gold standard for the diagnosis of this disease, and the first choice of treatment is to block the fistula under surgical microscope.