脊髄動静脈奇形—分類と診断のコツは？

Key of Classification and Diagnosis of Spinal Arteriovenous Malformation

Point

・原則的には脊髄動静脈奇形（AVM）は進行性の病変であり，初期診断が重要となるため，常に鑑別疾患の1つとして念頭に置く必要がある．

・まずは基本的な分類を理解することが，疾患頻度の低い脊髄AVMを把握する上では重要である．

・近年は造影CTAやMRAの診断精度が向上しているが，シャント部位の正確な同定や血流の詳細な評価には現在も脊髄DSAが必須である．

　Spinal arteriovenous malformation（AVM）is a rare disease in which blood is received from the spinal feeding arteries. Owing to its rarity, there is limited experience regarding its diagnosis and treatment. In addition, the various classifications that have been proposed historically make it more difficult for the young neurosurgeons to understand this disease. Because delayed initial diagnosis leads to irreversible damage of the spinal cord, neurosurgeons should always consider spinal AVM as one of the differential diagnoses. In order to understand the pathological condition of spinal AVM, it is important to learn basic classification. Spinal AVM is classified as intradural, dural, and epidural. Spinal digital subtraction angiography（DSA）is the gold-standard for the diagnosis of spinal AVM and is indispensable toolfor treatment planning. The purpose of this paper is to summarize a basic classification and diagnosis of spinal AVM.