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Spinale durale arteriovenöse Fisteln

Diagnostik und Therapie

Spinal dural arteriovenous fistulas

Diagnostics and therapy

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Zusammenfassung

Spinale durale arteriovenöse Fisteln (dAVF) sind seltene spinale vaskuläre Malformationen, die unbehandelt zu einer progredienten Paraparese und Paraplegie führen können. Da die klinischen Symptome oft unspezifisch sind, werden sie häufig erst in einem späteren Stadium diagnostiziert. Die Erkrankungshäufigkeit ist mit 5–10 Neuerkrankungen/1 Mio. Einwohner/Jahr relativ selten, über 80% der Betroffenen sind Männer. Der unbehandelt schlechte klinische Verlauf der dAVF sowie die Möglichkeit der Therapie, deren Erfolg von einer frühzeitigen Behandlung abhängt, macht sie jedoch zu einer wichtigen Erkrankung. Die Diagnose ist häufig im MRT zu stellen, zur genauen Darstellung der Fistel ist eine selektive spinale Subtraktionsangiographie jedoch notwendig.

Ziel dieses Artikels ist, einen Überblick über die Epidemiologie, Ätiologie, Klinik und bildgebende Verfahren sowie therapeutischen Möglichkeiten dieser spinalen vaskulären Malformation zu geben. Voraussetzung zum grundlegenden Verständnis der duralen AVF sind genaue Kenntnisse der vaskulären spinalen Gefäßversorgung.

Abstract

Spinal dural arteriovenous fistulas are rare spinal vascular malformations which can cause progressive paraparesis and paraplegia if not treated. As symptoms are unspecific diagnosis is often delayed and clinical outcome is dependent on early therapy. While magnetic resonance imaging (MRI) is the first choice imaging procedure, selective spinal digital subtraction angiography is necessary to analyze the angioarchitecture and to plan the treatment. This article provides an overview on the epidemiology, etiology, clinical aspects and imaging features as well as therapeutic aspects of spinal dural arteriovenous fistulas. Knowledge of spinal vascular anatomy is the basis for understanding spinal dural arteriovenous fistulas.

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  1. Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland

    W. Reith, M. Kettner, A. Simgen & U. Yilmaz

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  1. W. Reith
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  2. M. Kettner
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  3. A. Simgen
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  4. U. Yilmaz
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Correspondence to W. Reith.

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Reith, W., Kettner, M., Simgen, A. et al. Spinale durale arteriovenöse Fisteln. Radiologe 52, 437–441 (2012). https://doi.org/10.1007/s00117-011-2293-9

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