Stapleton Christopher J, Patel Anoop P, Walcott Brian P, Torok Collin M, Koch Matthew J, Leslie-Mazwi Thabele M, Rabinov James D, Butler William E, Patel Aman B
1 Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
2 Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Interv Neuroradiol. 2018 Jun;24(3):331-338. doi: 10.1177/1591019917754038. Epub 2018 Feb 12.
Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion.
背景 尽管技术进步提高了血管内技术治疗天幕硬脑膜动静脉瘘（DAVF）的疗效，但以内侧颈内动脉（ICA）供血为主的岩上窦（SPS）DAVF常常需要手术干预才能实现根治。方法 为比较血管内介入和手术干预治疗SPS DAVF患者的血管造影和临床结果，回顾了2010年8月至2015年11月所有天幕DAVF患者的记录。结果 在该队列中，8例患者的9处SPS DAVF符合评估条件。5处DAVF最初接受血管内栓塞治疗，4处未行栓塞直接接受手术闭塞。在接受栓塞治疗的SPS DAVF中，2处（40%）随访时仍闭塞，其余3处（60%）持续存在/复发，需要手术干预以彻底闭合。在直接接受手术闭塞治疗的4处SPS DAVF中，4处（100%）随访时仍保持闭合。此外，在栓塞后持续存在/复发并需要后续手术闭合的3处SPS DAVF中，3处（100%）随访时仍闭塞。成功接受栓塞治疗的2处（100%）SPS DAVF有颈外动脉主要或次要供血，而3处（100%）持续病变经脑膜垂体干（MHT）由颈内动脉主要供血。直接接受手术闭塞治疗的4处SPS DAVF中有3处（75%）由MHT主要供血。结论 经MHT由颈内动脉主要供血的SPS DAVF可能难以通过血管内治疗完全闭合，而早期手术干预完全闭塞率较高。
