Spinal Vascular Malformation Surgery

Spinal vascular malformations can be divided into arteriovenous malformations, venous malformations, cavernous hemangioma and telangiectasia. Such as causing spinal dysfunction, more advocated surgical resection. Treatment of diseases: spinal cord cavernous hemangioma spinal vascular malformation Indication 1. Spinal cord lesions were confirmed by spinal cord angiography or selective spinal angiography as spinal cord vascular malformations, symptoms progressively worsened, nerve root pain was significant, and there was a history of subarachnoid hemorrhage. 2. Spinal vascular malformations found in spinal canal-spinal exploration. Contraindications 1. Although the preoperative diagnosis has been established, the spinal cord dysfunction is complete, lasting 3 to 4 years, and it is estimated that there is no possibility of recovery after surgery. 2. The general condition is too bad to tolerate the operator. Preoperative preparation 1. Non-urgent patients should start skin preparation before 3 days, and then disinfect and dress before surgery. If you are in an emergency, you should prepare your skin carefully and disinfect it. 2. Prevent the occurrence of hemorrhoids. If it has already occurred, he should be treated properly before surgery. 3. If the patient has urinary tract infection or high fever, it is necessary to control acute infection, and surgery should be performed after the body temperature drops. 4. For high paraplegia, respiratory insufficiency, should pay attention to prevention and control of lung infections, especially for the elderly. 5. Anemia patients should receive a small number of blood transfusions before surgery, and blood preparation during surgery is about 400ml. Surgical procedure 1. Take the midline incision centered on the lesion and remove the corresponding lamina within the lesion. The range of vascular malformation can often be extensive, so it is often necessary to remove 5 to 6 laminas in one operation. 2. When cutting the dura mater, care should be taken not to damage the deformed blood vessels below it to avoid bleeding. At this time, the type of vascular malformation, the location of the deformed lesion, the supply artery, and the drainage vein were examined. The root arteries in the lesion often supply blood to the deformed blood vessels, and the number varies, but one is often the main donor. The blood supply artery is often penetrated into the meninges by the epidural nerve roots, located on the dorsolateral side of the spinal cord, thick and bright red, with pulsation. A small segment of the artery can be separated first, and the blood flow is temporarily blocked by the arterial clip. If the distal end of the blood vessel collapses, discolors, and beats disappear, it can be cut by bipolar coagulation and then cut. If this phenomenon is not observed, the main blood supply artery can be blocked, and other arteries only cut off the branches of the deformed lesion to ensure blood supply to the spinal cord. The deformity foci are located in the subarachnoid space on the dorsal side or both sides of the spinal cord, or have penetrated into the soft meninges, but the scope is small, and there is a clear boundary with the spinal cord tissue, and surgical resection is feasible. Capillary dilatation is often located under the soft meninges, and the anatomical relationship between the blood vessels and the spinal cord tissue cannot be determined under the operating microscope, so it is not appropriate to have a surgical resection. Under the operating microscope, the arachnoid surrounding the deformed blood vessels is sharply separated, and the deformed blood vessels should not be clamped directly with tweezers to avoid rupture, and the arachnoid covering the surface can be pulled by the microscopic sputum. The arachnoid fibers between the malformed blood vessels and between the blood vessels and the spinal cord are cut with a micro-shear. The anastomotic branch between the malformed blood vessel and the subdural blood vessel can be cut off after treatment with bipolar coagulation near the deformed blood vessel; a few coarser ones should be clipped with a silver clip before electrocoagulation. When the deformed foci are resected, the entangled vascular mass is completely separated from the surface of the spinal cord, and it is not necessary to separate the blood vessels adhering to each other. Because the blood pressure in the arteriovenous malformation of the spinal cord is not high, if there is bleeding from a blood vessel, it can be controlled by bipolar coagulation. The reflux vein is generally located on the dorsal side of the spinal cord, with multiple segments extending upward. After the deformed foci are removed, the vein is dissected toward the head end, and the branch of the confluent vein is cut along the way until the blood changes from arterial to venous. Stump bipolar coagulation treatment, silver clips can be added if necessary. The principle of spinal vascular malformation surgery is the same as that of intracranial vascular malformation surgery, that is, the supply of the artery is first treated, then the deformed lesion is removed, and the drainage vein is finally cut off. Do not ligature the drainage vein first, otherwise it will cause bleeding in the deformed foci and aggravate the spinal cord damage [Figure 1]. 3. After the hemostasis is completed, the dura mater and the layers of tissue are sutured in layers. complication 1. Spinal injury. 2. Bleeding.