Geibprasert Sasikhan, Pereira Vitor, Krings Timo, Jiarakongmun Pakorn, Toulgoat Frederique, Pongpech Sirintara, Lasjaunias Pierre
Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Stroke. 2008 Oct;39(10):2783-94. doi: 10.1161/STROKEAHA.108.516757. Epub 2008 Jul 17.
The craniospinal epidural spaces can be categorized into 3 different compartments related to their specific drainage role of the bone and central nervous system, the ventral epidural, dorsal epidural, and lateral epidural groups. We propose this new classification system for dural arteriovenous shunts and compare demographic, angiographic, and clinical characteristics of dural arteriovenous shunts that develop in these 3 different locations.
Three hundred consecutive cases (159 females, 141 males; mean age: 47 years; range, 0 to 87 years) were reviewed for patient demographics, clinical presentation, multiplicity, presence of cortical and spinal venous reflux, and outflow restrictions and classified into the 3 mentioned groups.
The ventral epidural group (n=150) showed a female predominance, more benign clinical presentations, lower rate of cortical and spinal venous reflux, and no cortical and spinal venous reflux without restriction of the venous outflow. The dorsal epidural group (n=67) had a lower mean age and a higher rate of multiplicity. The lateral epidural group (n=63) presented later in life with a male predominance, more aggressive clinical presentations, and cortical and spinal venous reflux without evidence of venous outflow restriction. All differences were statistically significant (P<0.001).
Dural arteriovenous shunts predictably drain either in pial veins or craniofugally depending on the compartment involved by the dural arteriovenous shunt. Associated conditions (outflow restrictions, high-flow shunts) may change that draining pattern. The significant differences between the groups of the new classification support the hypothesis of biological and/or developmental differences in each epidural region and suggest that dural arteriovenous shunts are a heterogeneous group of diseases.
颅脊髓硬膜外间隙可根据其对骨骼和中枢神经系统的特定引流作用分为3个不同的腔室，即腹侧硬膜外、背侧硬膜外和外侧硬膜外组。我们提出这种针对硬脑膜动静脉分流的新分类系统，并比较在这3个不同部位发生的硬脑膜动静脉分流的人口统计学、血管造影和临床特征。
回顾了连续300例病例（159例女性，141例男性；平均年龄：47岁；范围，0至87岁）的患者人口统计学、临床表现、多发性、皮质和脊髓静脉反流情况以及流出受限情况，并将其分为上述3组。
腹侧硬膜外组（n = 150）女性居多，临床表现更良性，皮质和脊髓静脉反流率较低，且在无静脉流出受限的情况下无皮质和脊髓静脉反流。背侧硬膜外组（n = 67）平均年龄较低，多发性发生率较高。外侧硬膜外组（n = 63）发病较晚，男性居多，临床表现更具侵袭性，且有皮质和脊髓静脉反流但无静脉流出受限的证据。所有差异均具有统计学意义（P < 0.001）。
硬脑膜动静脉分流根据其累及的腔室可预测地引流至软脑膜静脉或向颅外引流。相关情况（流出受限、高流量分流）可能会改变这种引流模式。新分类各组之间的显著差异支持了每个硬膜外区域存在生物学和/或发育差异的假设，并表明硬脑膜动静脉分流是一组异质性疾病。
