PDF(Sci-hub)
Abstract：
Perimedullary fistulae of the spinal cord are rare vascular lesions that can present with different clinical patterns: hemorrhage, progressive myelopathy due to arterial steal and/or venous congestion, or symptoms due to compression of neural structures by engorged vessels. Treatment consists of surgical excision, endovascular embolization, or a combination of the two. If complete obliteration of the nidus exposes the patient to undue risk of permanent neurological deficits, incomplete obliteration with reduction of the vascular supply is a reasonable compromise to improve clinical symptomatology. Partial devascularization may also alter the natural history by decreasing the risk of further growth and bleeding. In this video we illustrate the case of a patient with a perimedullary fistula of the conus treated with surgical disconnection of the main fistulous component. Partial devascularization resulted in resolution of MRI signal changes and symptoms with documented good clinical and radiological outcome and progressive regression of the residual nidus over six years of follow-up.
摘要：
脊髓的髓周瘘是罕见的血管病变，可以表现出不同的临床模式：出血，由于动脉盗血和/或静脉充血引起的进行性脊髓病，或由于血管充血压迫神经结构而引起的症状。治疗包括手术切除，血管内栓塞,或两者的组合。如果病灶完全消失会使患者面临永久性神经功能缺损的过度风险，血管供应减少的不完全闭塞是改善临床症状的合理折衷。部分断流也可以通过降低进一步生长和出血的风险来改变自然史。在本视频中，我们说明了患有圆锥髓周瘘管的患者的情况，该患者通过手术断开主要瘘管组件进行了治疗。部分血运重建导致MRI信号变化和症状的消退，并在六年的随访中记录了良好的临床和放射学结果以及残余病灶的逐渐消退。
