Jiang Chuhan, Lv Xianli, Li Youxiang, Zhang Jingbo, Wu Zhongxue
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Neuroradiology. 2009 Feb;51(2):103-11. doi: 10.1007/s00234-008-0473-8. Epub 2008 Nov 7.
An increasing number of intracranial dural arteriovenous fistulas (DAVFs) are amenable to endovascular treatment with Onyx-18. We reviewed our experience with the endovascular management of tentorial dural arteriovenous fistulas (TDAVFs) treated transarterially and transvenously.
Clinical records for 19 consecutive patients (three women, 16 men) with TDAVFs treated endovascularly between 2005 and 2008 were reviewed to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Most patients (78.9%) presented with intracranial hemorrhage (ICH). All patients had high-risk angiographic features such as leptomeningeal venous varix.
Transarterial embolization was performed in 19 patients. Transvenous embolization was additionally performed in two patients and caused one death. At the time of the last follow-up evaluation, 16 (84.2%) patients had good or excellent outcomes (modified Rankin score, 0 or 1) and one (5.3%) was deceased. Six patients had a residual fistula and were treated with gamma knife radiosurgery. The overall morbidity and mortality rate was 10.5%.
High-risk TDAVFs can be successfully managed with good outcomes. When anatomic features can be accessed endovascularly, endovascular treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further radiosurgery.
越来越多的颅内硬脑膜动静脉瘘（DAVF）适合采用Onyx - 18进行血管内治疗。我们回顾了经动脉和静脉治疗小脑幕硬脑膜动静脉瘘（TDAVF）的血管内治疗经验。
回顾了2005年至2008年间连续19例接受血管内治疗的TDAVF患者（3例女性，16例男性）的临床记录，以确定其临床表现、血管造影特征、血管内治疗方法及临床结局。大多数患者（78.9%）表现为颅内出血（ICH）。所有患者均具有如软脑膜静脉瘤样的高风险血管造影特征。
19例患者接受了经动脉栓塞治疗。另外2例患者接受了经静脉栓塞治疗，其中1例死亡。在最后一次随访评估时，16例（84.2%）患者预后良好或极佳（改良Rankin评分0或1），1例（5.3%）死亡。6例患者存在残余瘘，接受了伽玛刀放射外科治疗。总体发病率和死亡率为10.5%。
高风险TDAVF可通过血管内治疗成功管理，预后良好。当血管造影特征可通过血管内途径处理时，应进行血管内治疗。对于DAVF仍有残余充盈的患者，应考虑辅助治疗，包括进一步的放射外科治疗。
