Therapeutic effect analysis on microsurgery of spinal dural arteriovenous fistula in craniocervical junction
Objective To investigate the safety and efficacy of microsurgery in the treatment of spinal dural arteriovenous fis-tula(SDAVF)in craniocervical junction.Methods It was analyzed retrospectively the clinical data of 25 patients with craniocervi-cal junction SDAVF who underwent microsurgery in the Department of Neurosurgery of the Eastern Theater General Hospital from De-cember 2008 to December 2021.Among them,11 patients with hemorrhage(hemorrhage group)had acute onset of spontaneous sub-arachnoid hemorrhage(SAH),and 14 patients without hemorrhage(non-hemorrhage group).The Kamofsky Functional status(KPS)score was used to evaluate the patients'health status and quality of life before and after surgery.Results The head CT of 11 pa-tients showed that 1 patient had intraoperative hemorrhage,the other patients did not have hemorrhage,and SAH was significantly re-duced.CTA did not show abnormal thickening and tortuous blood vessels in the craniocervical junction,and DSA showed complete oc-clusion of the fistula.Postoperative head and neck MRI of the 14 non-bleeding patients showed cervical spinal cord swelling in 1 pa-tient,cervical spinal cord edema and empty vascular shadow were not observed in the other patients,MRA showed no abnormal vascu-lar shadow in the craniocervical junction,and DSA showed complete occlusion of the fistula.All patients had complete occlusion of fis-tula during operation and no abnormal postoperative DSA.The postop-erative functional status of patients in the hemorrhage group was sig-nificantly improved compared with that before surgery(P<0.001).No complaints of discomfort were reported in 7 patients during follow-up,and no fistula was found in DSA review.The postoperative functional status of the patients in the non-bleeding group was significantly im-proved compared with that before surgery(P<0.001).No complaints of discomfort were reported in all the 9 patients during follow-up,and no fistula was found in DSA review.Conclusion Microsur-gery is an effective method for the treatment of craniocervical junction SDAVF,which can significantly improve the prognosis of pa-tients.
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