胸腰椎部硬膜動静脈瘻の術中所見と治療結果の検討

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  • Analysis of Intraoperative Findings and Therapeutic Results of Thoracolumbar Dural Arteriovenous Fistula

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<p>  Objective : We analyzed the clinical presentation, therapeutic outcome, and intraoperative findings of thoracolumbar dural arteriovenous fistula (T-L dAVF).</p><p>  Method and material : We experienced 19 cases (16 men) of T-L dAVF between 1996 and 2011 and analyzed the clinical characteristics and outcome after intravascular embolization and direct surgery. Additionally, we analyzed intraoperative findings among the cases that underwent direct surgery.</p><p>  Result : The mean patient age was 63.8 years, and the mean follow-up period after intravascular embolization and/or direct surgery was 72.2 months. All patients suffered congestive myelopathy. Intravascular embolization was performed in 15 cases. All 4 patients who underwent feeder occlusion with coil material had a relapse and required direct surgery. Eight of eleven patients treated with n-butyl cyanoacrylate (NBCA) were cured. One patient suffered a spinal infarction after embolization. Three cases treated by NBCA showed recurrence and required direct surgery. All 10 cases that required direct surgery were cured without any complications. During the direct surgeries, single draining vein was observed in all 10 cases. The draining vein was located dorsally against the posterior rootlet in 8 cases, ventrally in 1 case, and intraforaminally in 1 case. Vascular tangle was observed on the outer surface of the dura mater in 4 cases, on the inner surface of the dura mater in 3 cases, and on both the inner and outer surfaces in 2 cases. The fistulous point was located around the dural sleeve or the corresponding pedicle in all but 1 case.</p><p>  Conclusion : Regarding therapy for T-L dAVF, direct surgery may be more promising than intravascular embolization, although the latter can be performed less invasively. We must remember that cases of T-L dAVF in which the fistulae are located far from the dural root sleeve or corresponding pedicle are rare.</p>

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  • 脊髄外科

    脊髄外科 27 (1), 45-51, 2013

    日本脊髄外科学会

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