Griauzde Julius, Gemmete Joseph J, Pandey Aditya S, Chaudhary Neeraj
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
J Neurointerv Surg. 2017 Jun;9(6):583-586. doi: 10.1136/neurintsurg-2016-012418. Epub 2016 Jun 8.
To present our experience with endovascular treatment of dural carotid cavernous fistulas (DCCFs) and determine if there is a correlation between clinical symptoms and the Cognard classification system.
We searched our institutional neurovascular database to identify patients treated for DCCFs from January 1995 to May 2015. DCCFs were defined as a vascular shunt between meningeal branches of the internal carotid artery (ICA), external carotid artery (ECA), or both, draining into the cavernous sinus. Clinical symptoms were recorded based on clinical examination. Lesions were classified on angiography using the Cognard and Barrow classification systems. Treatment goal was defined as symptomatic cure based on clinical examination, cure of ophthalmic venous drainage, and cortical venous reflux on angiography.
The search revealed 37 patients with DCCFs; 32 DCCFs underwent endovascular treatment. The primary treatment goal was met in 30/32 (94%) lesions, with one neurologic complication (1/34; 3%). We identified 31 Cognard IIa fistulas, 4 Cognard IIa+b, 2 Cognard IIb, 7 Barrow B, 7 Barrow C, and 23 Barrow D fistulas. Eye redness, proptosis, and ocular pain were significantly lower in the Cognard IIb group than in the Cognard IIa and IIa+b groups (p=0.0015). Intracranial hemorrhage was more likely in the Cognard IIb group than in the Cognard IIa and IIa+b groups, with marginal significance (p=0.054). No correlation was seen between symptomatology and the Barrow classification.
Endovascular treatment of DCCFs has a high degree of clinical success and a low complication rate. The Cognard system is suitable for grading DCCFs as it correlates with presenting symptomatology and venous drainage patterns. The Barrow classification adds no value in grading DCCFs.
介绍我们对硬脑膜动静脉瘘（DCCF）进行血管内治疗的经验，并确定临床症状与科尼亚尔分类系统之间是否存在相关性。
我们检索了机构神经血管数据库，以确定1995年1月至2015年5月期间接受DCCF治疗的患者。DCCF被定义为颈内动脉（ICA）、颈外动脉（ECA）或两者的脑膜分支之间的血管分流，引流至海绵窦。根据临床检查记录临床症状。使用科尼亚尔和巴罗分类系统在血管造影上对病变进行分类。治疗目标定义为基于临床检查的症状治愈、眼科静脉引流的治愈以及血管造影上的皮质静脉反流。
检索发现37例DCCF患者；32例DCCF接受了血管内治疗。30/32（94%）个病变达到了主要治疗目标，有1例神经并发症（1/34；3%）。我们确定了31例科尼亚尔IIa型瘘、4例科尼亚尔IIa + b型、2例科尼亚尔IIb型、7例巴罗B型、7例巴罗C型和23例巴罗D型瘘。科尼亚尔IIb组的眼红、眼球突出和眼痛明显低于科尼亚尔IIa组和IIa + b组（p = 0.0015）。科尼亚尔IIb组比科尼亚尔IIa组和IIa + b组更易发生颅内出血，具有边缘显著性（p = 0.054）。症状学与巴罗分类之间未见相关性。
DCCF的血管内治疗具有高度的临床成功率和低并发症发生率。科尼亚尔系统适用于对DCCF进行分级，因为它与呈现的症状学和静脉引流模式相关。巴罗分类在DCCF分级中没有增加价值。
