Li C, Yang X, Li Y, Jiang C, Wu Z
Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, 100050, Beijing, People's Republic of China.
Clin Neuroradiol. 2016 Sep;26(3):301-8. doi: 10.1007/s00062-014-0362-y. Epub 2014 Dec 13.
The purpose of this study was to evaluate the effectiveness and safety as well as the clinical and angiographic results of endovascular treatment (EVT) for patients with hemorrhagic dural arteriovenous fistulas (DAVFs).
From April 2009 to November 2013, 46 consecutive patients (7 women, 39 men; mean age, 46.7 years) diagnosed with hemorrhagic intracranial DAVFs at our department were enrolled in this study. Clinical and angiographic data were reviewed and evaluated.
Two fistulas were cured by transvenous approach, and all other fistulas were embolized through transarterial route. After treatment with last embolization, a residual shunt was observed in 15 patients, including near-total obliteration of the fistula in 6 patients (13.0 %) and partial obliteration of the fistula in 9 patients (19.6 %). Seven of them underwent supplementary Gamma knife surgery. Complications occurred during or after EVT in six patients. One patient died 10 days after EVT because of complications of Onyx embolus into the posterior inferior cerebellar artery. Other complications included microcatheter entrapment in one case, trigeminocardiac reflex in one, facial nerve paresis in two, and occulomotor nerve paresis in one. The facial nerve paresis in one patient markedly improved but did not completely resolve during follow-up period. The other four patients recovered well, without symptoms at clinical follow-up. Angiographic follow-up result was obtained in 35 cases, with complete obliteration in 27 of them (77.1 %). Clinical follow-up outcomes were good, with 38 patients (82.6 %) reporting modified Rankin Scale of either 0 or 1. No patient suffered recurrent intracranial hemorrhage during follow-up.
EVT was effective and safe in the modern management of ruptured intracranial DAVFs, with complete cure in most lesions. Clinical outcomes were good despite patients presenting with intracranial hemorrhage.
本研究旨在评估血管内治疗（EVT）对出血性硬脑膜动静脉瘘（DAVF）患者的有效性、安全性以及临床和血管造影结果。
2009年4月至2013年11月，本研究纳入了在我科连续诊断为出血性颅内DAVF的46例患者（7例女性，39例男性；平均年龄46.7岁）。回顾并评估临床和血管造影数据。
2例瘘通过静脉途径治愈，所有其他瘘通过动脉途径栓塞。在最后一次栓塞治疗后，15例患者观察到残余分流，其中6例患者（13.0%）瘘几乎完全闭塞，9例患者（19.6%）瘘部分闭塞。其中7例患者接受了辅助伽玛刀手术。6例患者在EVT期间或之后出现并发症。1例患者在EVT后10天因Onyx栓塞进入小脑后下动脉的并发症死亡。其他并发症包括1例微导管嵌顿、1例三叉神经心脏反射、2例面神经麻痹和1例动眼神经麻痹。1例患者的面神经麻痹在随访期间明显改善但未完全恢复。其他4例患者恢复良好，临床随访无症状。35例患者获得血管造影随访结果，其中27例（77.1%）完全闭塞。临床随访结果良好，38例患者（82.6%）改良Rankin量表评分为0或1。随访期间无患者发生复发性颅内出血。
EVT在现代治疗破裂颅内DAVF中有效且安全，大多数病变可完全治愈。尽管患者出现颅内出血，但临床结果良好。
