Evalution Of Endovascular Treatment Of Spinal Arteriovenous Fistulae

【BACKGROUND】:Dural arteriovenous fistula (spinal dural arteriovenous fistulae, SDAVF) is the mostcommon type of spinal vascular disease,accounting for70-80%of spinal cord disease,common in middle-aged men. The annual incidence rate is5-10/1000000people. Themajor clinical manifestatons include paralysis of the lower limbs, and urine and stoolincontinence, and about50%of cases with pathological positive consideration may beassociated with edema of spinal cord. Due to the low incidence of SDAVF andnon-specific clinical symptoms, results SDAVF can be misdiagnosed as lumbar discherniation, myelitis and so on. Conventional MRI of the spinal cord is considered one ofthe most valuable screening tool SDAVF, and characteristic features are: the surface of thespinal cord blood flow expansion tortuous empty shadow, with the correspondingsegments of the spinal cord edema. But spinal MRI examination is not SDAVF goldstandard for diagnosis. And as the gold standard for diagnosis SDAVF spinal angiographyis certain traumatic and risky, it cause SDAVFs hard to early diagnose and widespreadmisdiagnosis and mistreatment. SDAVF clinical onset and more occult and slow progress,showing symptoms of spinal nerve root damage aggravated sexual. But when SDAVF patients with spinal venous drainage within the normal venous disorders, spinal cordappears hemodynamic decompensation, manifested as Koix-Alajouanine syndrome: thespinal dural arteriovenous fistula causing substantive venous hypertension, venous cordreflux disorder, spinal cord ischemia secondary veins, resulting in spinal corddysfunction can be further developed into spinal cord ischemia and necrosis, highmorbidity, patients can complete paraplegia within a few days to a month, seriouslyaffecting the quality of life of patients. Pathogenesis of dural arteriovenous fistula is stillnot very clear, the disease was first raised in1977from Kendall, then there are a numberof laboratories have elaborated the pathogenesis and pathophysiology of the disease. Atpresent, most scholars are inclined that the disease is an acquired disease, and is the mainpathological mechanism is SDAVF spinal venous hypertension. Currently, Treatmentmethods of dural arteriovenous fistula include surgical treatment methods andendovascular embolization. Previous surgical treatment is effective, Steinmetz et datathrough the multi-center meta-analysis results, SDAVF surgical cure rate can be as high as98%. The traditional SDAVF endovascular treat, cure rate of only46%, and a higherrelapse rate, Niimi et al reported after embolization of the fistula recurrence rate is13%-20%. However, surgical treatment is traumatic relatively. Minimally invasiveendovascular embolization with lower preoperative physical status of the requirements,intraoperative positioning accuracy, row after spinal angiography can be rapid treatmentand so on. And in recent years, with the gradual development of interventional techniquesand materials science, especially the emergence of Onyx embolization glue, makingdural arteriovenous fistula endovascular embolization are becoming increasinglysophisticated, both in the SDAVDF thrombosis embolism or in the cure rate on the fistularecurrence rate averaged more obvious improvements and easier for patients to accept.However, the clinical efficacy of the implementation of the application Onyx glueendovascular embolization of dural arteriovenous fistula is currently no large single-centercase reports.【AIMS】Microsurgical treatment of spinal dural arteriovenous fistula results for the same period of comparison evaluate the clinical efficacy of endovascular treatment of duralarteriovenous fistula (SDAVFs) application via the artery approach Onyx gum line.【METHODS】The clinical data about treatment and outcomes of55consecutive patients withspinal dural artefiovenous fistula treated from2007to2013were analyzed retrospectively.【RESULT】24patients undergoing endovascular embolization and resulted in a complete occlusion of the fistula in19cases (79.16%) by angiogram.19patients were followed up(1-12months), level of9patients (47.05%) are improved according to the Aminoff-Logue scale(ALS) scale. Excluding3patients refused to angiography, angiographic follow up was obtained in other cases，and no fistula was observed.【CONCLUSION】Under strict grasp dural arteriovenous fistula (SDAVF) embolization surgical indications premise arterial road into the gum line application Onyx endovascular embolization of spinal dural arteriovenous fistula (SDAVF) is safe, feasible and effective.