目的:颈脊髓高度复杂的性质可导致这些节段的动静脉分流,这可能与增加的临床风险和治疗复杂性有关。在这篇文章中,作者旨在提供详细的自然过程的全面分析,治疗,以及基于迄今为止最大队列的颈脊髓动静脉分流术(SCAVSs)的临床结果。
方法:纳入240例连续患者。临床表现数据,血管建筑学,治疗,并对随访情况进行回顾性分析.
结果:队列显示急性发作的患病率更高(63.3%vs36.7%)。63.7%的患者在发病后观察到自发恢复,在急性发作患者中观察到的恢复率显着升高(72.4%vs48.9%,p<0.001)。发病后急性和逐渐临床恶化的风险为11.9%/年和13.4%/年,分别。39.6%的患者进行了显微外科手术,而其余60.4%的人完全接受了栓塞。显微手术后完全闭塞率为65.3%,栓塞后为21.4%。显微外科术后治疗相关恶化率为14.7%,栓塞术后为6.2%。部分治疗后,急性和逐渐恶化率分别为4.1%/年和6.6%/年,分别。发病后缺乏自发恢复是栓塞相关恶化(OR17.905,p=0.007)和部分治疗后长期逐渐恶化(HR2.325,p=0.021)的独立预测因素。经过32.55个月的中位随访期,16.7%的患者预后不良,唯一的独立危险因素是发病后没有自发恢复(OR2.476,p=0.018)。
结论:宫颈SCAVS患者的预后总体良好,即使在只有部分病灶消失的患者中。然而,发病后无自发恢复趋势的患者预后不良的风险显著升高,强调需要及时进行临床干预。
OBJECTIVE: The highly intricate nature of the cervical spinal cord can cause arteriovenous shunts in these segments that may be associated with heightened clinical risks and treatment complexities. In this article, the authors aimed to provide a comprehensive analysis of the detailed natural course, treatment, and clinical outcomes of cervical spinal cord arteriovenous shunts (SCAVSs) based on the largest cohort to date.
METHODS: Two hundred forty consecutive patients were included. Data on clinical presentation, angioarchitecture, treatment, and follow-up were retrospectively reviewed.
RESULTS: The cohort demonstrated a greater prevalence of acute onset (63.3% vs 36.7%). Spontaneous recovery was observed in 63.7% of patients after onset, with a significantly elevated recovery rate observed among patients experiencing acute onset (72.4% vs 48.9%, p < 0.001). The risks of acute and gradual clinical deterioration after onset was 11.9%/year and 13.4%/year, respectively. Microsurgery was performed in 39.6% of patients, while the remaining 60.4% exclusively underwent embolization. The complete obliteration rate was 65.3% after microsurgery and 21.4% after embolization. The rate of treatment-related deterioration was 14.7% after microsurgery and 6.2% after embolization. After partial treatment, the acute and gradual deterioration rates were 4.1%/year and 6.6%/year, respectively. Lack of spontaneous recovery after onset was an independent predictor of embolization-related deterioration (OR 17.905, p = 0.007) and long-term gradual deterioration after partial treatment (HR 2.325, p = 0.021). After a median follow-up period of 32.55 months,
prognosis was unfavorable in 16.7% of patients, with the sole independent risk factor being the absence of spontaneous recovery after onset (OR 2.476, p = 0.018).
CONCLUSIONS: The outcomes of patients with cervical SCAVS were generally favorable, even in patients with only partial obliteration of the lesions. However, patients who did not show a trend toward spontaneous recovery after onset had a significantly elevated risk of unfavorable
prognosis, highlighting the need for prompt clinical intervention.