Department of Neurosurgery, Military Hospital, Rabat, Morocco.
World Neurosurg. 2013 Jan;79(1):182-91. doi: 10.1016/j.wneu.2012.09.012. Epub 2012 Sep 23.
Intracranial dural arteriovenous fistulas with perimedullary venous drainage (IDAVFPD) are classified as type V dural arteriovenous fistulas. Publications are limited to single case reports and small case series. We conducted a systematic review of the literature for patients with IDAVFPD. The aim of this study is to identify the predictive factors of poor prognosis in patients with IDAVFPD.
We present the case of a 48-year-old man who underwent surgical interruption of IDAVFPD. A complete MEDLINE search was then undertaken for all articles reporting outcomes data for IDAVFPD. According to the results we have divided the patient population into two groups: I, those patients who showed improvement after treatment, and II: those patients who did not show improvement. We conducted a comparative statistical analysis of the epidemiologic, clinical, radiologic, and therapeutic parameters between the two groups.
A total of 37 articles comprising with 58 cases were included for analysis with an average follow-up of 12 months. There were 36 patients in group I and 22 in group II. The average age was 57.8 years in group I and 54.3 years in group II (P=0.32). Onset of symptoms was acute or subacute in 57% of patients in group I, and in 50% of patients in group II (P=0.62). Bulbar signs were present in 28% of cases in group I and in 36% of cases in group II (P=0.49). Hyperintensity of the brainstem on T2-weighted sequence magnetic resonance imaging was more common in patients in group II (78%) compared with patients in group I (45%) (P=0.012). Patients who underwent surgical procedure have shown good outcomes compared to patients treated with endovascular approach (P=0.039).
The poor outcomes were correlated to the presence of brainstem signal abnormalities on magnetic resonance imaging, whereas the prognosis does not depend on age, sex, clinical presentation, or anatomic characteristics of the fistula.
硬脑膜动静脉瘘伴脊髓髓周静脉引流（IDAVFPD）被归类为 V 型硬脑膜动静脉瘘。此类出版物仅限于单病例报告和小病例系列。我们对 IDAVFPD 患者进行了系统的文献回顾。本研究的目的是确定 IDAVFPD 患者预后不良的预测因素。
我们报告了一名 48 岁男性患者的病例，该患者接受了 IDAVFPD 的手术阻断。然后，我们对所有报告 IDAVFPD 结局数据的文章进行了完整的 MEDLINE 检索。根据结果，我们将患者人群分为两组：I 组为治疗后改善的患者，II 组为未改善的患者。我们对两组的流行病学、临床、影像学和治疗参数进行了比较统计分析。
共有 37 篇文章（共 58 例）纳入分析，平均随访 12 个月。I 组有 36 例，II 组有 22 例。I 组的平均年龄为 57.8 岁，II 组为 54.3 岁（P=0.32）。I 组 57%的患者症状为急性或亚急性起病，II 组 50%的患者症状为急性或亚急性起病（P=0.62）。I 组 28%的病例有球部体征，II 组 36%的病例有球部体征（P=0.49）。T2 加权磁共振成像上脑干高信号在 II 组更为常见（78%），而在 I 组则更为常见（45%）（P=0.012）。与血管内治疗相比，手术治疗的患者预后较好（P=0.039）。
不良预后与磁共振成像上脑干信号异常有关，而预后与年龄、性别、临床表现或瘘管的解剖特征无关。
