Choi Jai Ho, Jo Kyung Il, Kim Keon Ha, Jeon Pyoung, Yeon Je Young, Kim Jong Soo, Hong Seung Chyul
Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Acta Neurochir (Wien). 2017 Aug;159(8):1479-1487. doi: 10.1007/s00701-017-3226-9. Epub 2017 May 31.
The aim of this study was to evaluate the clinical and angiographic characteristics of dural arteriovenous fistulas (DAVF) presenting with intracranial hemorrhage (ICH), with a focus on early rebleeding according to the initial hemorrhage type.
The clinical and radiologic features of 21 dAVFs that presented with intracranial hemorrhage were retrospectively reviewed. The hemorrhage type was classified as pure intraparenchymal hemorrhage (pIPH) and subarachnoid or subdural hemorrhage with IPH (non-pIPH).
There were 13 patients with pIPH and 8 with non-pIPH. The median follow-up period was 30 months (range, 1-116 months), and the median interval from hemorrhage to treatment was 4 days (range, 0-72 days). Rebleeding occurred in 8 (38.1%) of 21 patients. Four (50%) of eight patients with non-pIPH suffered from early rebleeding within 3 days, while there was no early rebleeding in patients with pIPH. There was a significantly higher rate of early rebleeding in the non-pIPH group (p = 0.012). Angiographically, venous ectasia (p = 0.005) and direct cortical venous drainage (dCVD) (p = 0.008) showed a significantly higher proportion in the non-pIPH group than in the pIPH group.
DAVFs with ICH is likely to rebleed after the first hemorrhage. Thus, early treatment can be needed in all DAVFs with ICH. In addition, DAVFs that presenting with non-pIPH and containing venous ectasia or dCVD on initial angiography may have a higher risk of early rebleeding. Therefore, cautious attention and urgent treatment are necessary for these patients.
本研究旨在评估表现为颅内出血（ICH）的硬脑膜动静脉瘘（DAVF）的临床和血管造影特征，重点关注根据初始出血类型的早期再出血情况。
回顾性分析21例表现为颅内出血的DAVF的临床和影像学特征。出血类型分为单纯脑实质内出血（pIPH）和蛛网膜下腔或硬膜下出血合并脑实质内出血（非pIPH）。
13例为pIPH，8例为非pIPH。中位随访期为30个月（范围1 - 116个月），出血至治疗的中位间隔时间为4天（范围0 - 72天）。21例患者中有8例（38.1%）发生再出血。8例非pIPH患者中有4例（50%）在3天内发生早期再出血，而pIPH患者中无早期再出血。非pIPH组早期再出血率显著更高（p = 0.012）。血管造影显示，非pIPH组静脉扩张（p = 0.005）和直接皮质静脉引流（dCVD）（p = 0.008）的比例显著高于pIPH组。
伴有ICH的DAVF首次出血后可能再出血。因此，所有伴有ICH的DAVF可能都需要早期治疗。此外，初始血管造影显示为非pIPH且伴有静脉扩张或dCVD的DAVF早期再出血风险可能更高。因此，对这些患者需要谨慎关注并紧急治疗。
