背景:为了评估混合手术的临床效果,其中包括脊髓血管造影辅助的显微外科手术,用于治疗硬脊膜动静脉瘘(SDAVF)。
方法:我们回顾性分析了在2019年9月至2022年6月期间接受混合硬膜动静脉瘘(SDAVF)切除术的45例患者。混合手术涉及术中数字减影血管造影(DSA)的脊髓血管,以确定供血动脉的来源,瘘管和引流静脉的位置,吲哚菁绿荧光(ICG)辅助的瘘管显微手术切除,术后DSA验证治疗效果。汉密尔顿焦虑量表(HAMA),汉密尔顿抑郁量表(HAMD),视觉模拟量表(VAS),Barthel得分,采用改良Rankin量表(mRS)和改良Aminoff-Logue评分(关键指标)评估SDAVF切除的临床效果。
结果:45例SDAVF患者行混合手术成功治疗,无瘘复发。术中无脊髓造影相关并发症,没有一个病人死亡.术后,两名患者出现脊髓功能临床恶化,表现为双侧下肢瘫痪和膀胱括约肌功能障碍。术后,在1-2天内观察到16例(35.6%)的mALS评分改善,1周时12例(26.7%),6个月时7例(15.6%)。术后6个月脊髓MRA检查未发现SDAVF复发。与术前mALS评分相比,35例(77.8%)症状明显改善,8例(17.8%),保持不变,和2例(4.4%)恶化。与术前评分相比,术后mALS评分明显下降[术后vs.术前:2(1,3)vs.3(2,4)],HAMD评分[(12.2±5.5)vs.(19.6±6.3)],HAMA评分[(15.6±5.5)与(20.5±6.5)],和VAS评分[3(2,5)vs.5(4,8)]。相反,Barthel得分显着增加[(74.6±8.7)与(67.8±9.2)](P<0.05)。然而,mRS评分低于术前[1(1,2)vs.2(1,2.5)],但差异无统计学意义(P>0.05)。与术前功能相比,随访时“良好”的神经系统预后显着增加(62.2%vs.33.3%)(P=0.023)。
结论:混合手术是SAVF患者安全有效的治疗方法,这有利于改善焦虑,抑郁症,脊髓,和神经功能,和减轻疼痛。然而,SDAVF患者的治疗是一个复杂的,需要进一步多学科干预的长期过程,包括临床护理,心理社会干预,和神经康复。
BACKGROUND: To assess the clinical effects of hybrid surgery, which includes spinal angiography-assisted microsurgery, in the treatment of spinal dural arteriovenous fistulas (SDAVF).
METHODS: We retrospectively reviewed 45 patients who underwent hybrid Spinal dural arteriovenous fistula (SDAVF) resection between September 2019 and June 2022. The hybrid surgery involved intraoperative digital subtraction angiography (DSA) of the spinal vessels to determine the source of the blood-supplying artery, location of the fistula and draining vein, indocyanine green fluorescence (ICG)-assisted microsurgical resection of the fistula, and postoperative DSA to verify therapeutic efficacy. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Visual Analog Scale (VAS), Barthel score, modified Rankin Scale (mRS) and modified Aminoff-Logue score (key indicator) were used to assess the clinical effects of SDAVF resection.
RESULTS: A series of 45 patients with SDAVF were successfully treated with hybrid surgery without fistula recurrence. There were no intraoperative complications related to spinal angiography, and none of the patients died. Postoperatively, two patients experienced clinical deterioration of spinal cord function, which manifested as bilateral lower extremity paralysis and bladder sphincter dysfunction. Postoperatively, improvement in mALS scores was observed in 16 cases (35.6%) within 1-2 days, 12 cases (26.7%) at 1 week, and 7 cases (15.6%) at 6 months. No SDAVF recurrence was detected in the spinal MRA examination 6 months after surgery. When compared with preoperative mALS scores, 35 cases (77.8%) showed significant improvement in symptoms, 8 cases (17.8%), remained unchanged, and 2 cases (4.4%) deteriorated. Compared with the preoperative scores, the postoperative mALS score was significantly decreased [postoperative vs. preoperative: 2(1,3) vs. 3(2,4)], HAMD score [(12.2 ± 5.5) vs. (19.6 ± 6.3)], HAMA score [(15.6 ± 5.5) vs. (20.5 ± 6.5)], and VAS score [3(2,5) vs. 5(4,8)]. Conversely, Barthel scoresshowed significant increase [(74.6 ± 8.7) vs. (67.8 ± 9.2)] (P < 0.05). However, the mRS scores were lower than preoperatively [1(1,2) vs. 2(1,2.5)], but the difference was not statistically significant (P > 0.05). There was a significant increase in \"good\" neurological outcomes at follow-up compared with preoperative function (62.2% vs. 33.3%) (P = 0.023).
CONCLUSIONS: Hybrid surgery is a safe and effective treatment for patients with SAVF, which is beneficial for improving anxiety, depression, spinal cord, and neurological function, and relieving pain. However, the treatment of patients with SDAVF is a complex, long-term process requiring further multidisciplinary interventions, including clinical care, psychosocial interventions, and neurorehabilitation.