脊髄動静脈奇形に対する直達手術の適応と工夫

Direct Surgery for Spinal Arteriovenous Shunt Disease: Indication and Technical Tips

Point

・脊髄動静脈短絡疾患は，この10年で疾患概念の整理が進み，その認知度も高まっている．

・精細な画像診断が可能になり，血管内治療の技術の進歩と相まって，血管内治療で対応可能なケースも増えている．

・一方，直達術は根治性に優れており，特に血管内治療困難例・ハイリスク例では，第一選択で行われるべきである．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　Spinal arteriovenous（AV）shunt disease is rare, although many neurosurgeons may encounter patients with the disease. Recently, the pathological findings and classification of spinal AV shunt disease have been well described. The fundamental treatment of spinal AV shunt disease involves interruption of the shunt, which is achieved by endovascular treatment or direct surgery. Development in diagnostic imaging and technology for endovascular treatment has enabled us to treat many cases. Recently, several multicenter studies on spinal AV shunt diseases revealed that the treatment outcomes of direct surgery were better than those of endovascular treatment. However, in our institute, endovascular treatment is the first line because it is less invasiveness. Although the success and complication rates of endovascular treatment are inferior to those of direct surgery, endovascular treatment remains a therapeutic option for patients with spinal AV shunt disease if it could achieve low complication rates and direct surgery could be performed afterward to rescue the patient. In this article, we elaborate on this disease, surgical indications, limitations of endovascular treatment, and tips for direct surgery.