Della Pepa Giuseppe Maria, Parente Paolo, D'Argento Francesco, Pedicelli Alessandro, Sturiale Carmelo Lucio, Sabatino Giovanni, Albanese Alessio, Puca Alfredo, Fernandez Eduardo, Olivi Alessando, Marchese Enrico
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
Institute of Hygiene and Population Medicine, Catholic University of Rome, Rome, Italy.
Neurosurgery. 2017 Aug 1;81(2):315-330. doi: 10.1093/neuros/nyw175.
High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses.
To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms).
The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage).
Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%.
Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk.
高级别硬脑膜动静脉瘘（dAVF）可呈现出血管构筑特征差异很大的分流情况。特定的血流动力学因素可能影响临床病程并决定截然不同的临床过程。
评估高级别dAVF的一些静脉血管构筑特征与临床表现之间的关系。分析了中度或重度静脉高压的特定指标，如硬脑膜窦形态改变（单一或双重血栓形成）或皮质血管过载（流出受限、假性静脉炎样皮质血管和静脉瘤）。
对本机构的病例系列进行回顾性分析（49例），并分析静脉引流模式与临床表现（良性/侵袭性/出血）之间的关系。
49例中有35例显示皮质反流（高级别dAVF）。该亚组中31.42%的病例表现为良性，31.42%为侵袭性，37.14%为出血性。
我们的数据证实，在高级别dAVF中，根据临床表现的严重程度存在两个不同的亚群。我们检查的一些指标与侵袭性非出血性表现（流出受限和假性静脉炎样皮质血管）相关，而其他指标与出血（双重血栓形成和静脉瘤）相关。目前的分类似乎不足以识别最终决定皮质静脉引流组织的广泛情况。与单纯的皮质反流定义相比，中度静脉充血程度与临床风险的相关性更好。本研究中呈现的静脉引流血管造影方面可能有助于评估dAVF的血流动力学特征并识别临床风险较高的情况。
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