Neuroendoscope-assisted Surgical Treatment Of Spinal Dural Arteriovenous Fistulas

Objective:To explore the neuroendoscope-assisted surgical treatment to spinal dural arteriovenous fistulas, and analyse the changes of spinal function and spinal DSA before and after treatment. Comparing the neuroendoscope-assisted and traditional surgical treatment, in order to minimize the surgical trauma and improve the quality of life.Methods:From November 2008 to July 2010,6 cases of spinal dural arteriovenous fistulas underwent neuroendoscope-assisted surgical treatment by hemilaminectomy approach in neurosurgery department of Qilu hospital. Retrospectively analyzed the 6 cases'clinical manifestations, imaging data, surgical methods, postoperative recovery and follow-up data. The 6 cases were all first attack, included 5 males(83.3%) and 1 female(16.7%),male to female ratio 5:1. The patients'age ranged from 48 to 67 years(mean age 58.3 years). The diagnostic time ranged from 6-36 months(mean 16.6 months). All cases had the spinal dysfunctions,3 cases'first symptom was the lower limbs'progressive powerless and had difficulty in walking,2 cases'lower limbs' numb and 1 case had impotence. With the development of the disease, all 6 cases had lower limbs'motor and sense dysfunction,4 cases had sphicteric dysfunction. Spinal cord's magnetic resonance imaging and selective spinal cord angiography were performed before preoperation. The T2-weighted sequences showed mass effect, the vessels on the back of spinal cord were dilated, coiled and flew voids. The selective spinal cord angiography showed the segment artery which harboring the fistula. Before the operation, all patients received routinely x-rays radiographs to mark the spinal process'position to guide the hemilaminectomy. In operation, after hemilaminectomy, found the draining vein and the fistula with the assistance of neuroendoscope. Fulgerized and cut the draining vein, the vein obviously collapsed and the colour turned into dull-red. Then fulgerized the fistula repeatly. Taking warfarin orally the next day after operation to anticoagulate for 3 months, and survived the prothrombin activity regularly.Results:6 cases were all single fistula, fulgerized the draining vein and fistla during the operation. The angiography before leaved the hospital showed all fistulas and draining veins were disappeared, achieved imaging cure.5 cases'lower limb's motor and sensory function had obviously improved,1 case had no chang.1 case's sphicteric function improved obviously,3 cases'had no change. After 3 months to 35 months'follow-up,13.8 months on average.2 cases'symptoms were disappeared, the score of Aminoff-Logue was 0,3 cases were obviously improved, the score of Aminoff-Logue had raised 1-2 points.1 case had no change, the score of Aminoff-Logue was still 3.Conclusion:With the development of the image technology and the understanding of SDAVF, the diagnostic rate has improved visibly. The neuroendoscope-assisted surgery can minimize the surgical injury, cut down the cost, reduce the hospital stays, according with the trends of "minimally invasive surgery". With the neuroendoscope's development in various hospitals, the neuroendoscope-assisted surgery can play important role in the treatment of spinal dural arteriovenous fistula.