Department of Neuroradiology, Antonio Cardarelli Azienda Ospedaliera di Rilievo Nazionale, Naples, Italy; Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy.
Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy.
World Neurosurg. 2019 Aug;128:e621-e631. doi: 10.1016/j.wneu.2019.04.220. Epub 2019 May 7.
Multiple carotid cavernous fistula (CCF) classifications have been proposed. However, they lacked predictive factors for the clinical presentation, natural history, and hemorrhagic risk. Our aim was to externally validate a new classification according to venous drainage (i.e., the Thomas classification [TC]) to assess its relationship with symptoms, endovascular treatment, and outcomes.
We performed a multicenter retrospective review of CCFs at 2 major academic institutions. The CCFs were classified using the Barrow classification (BC) and TC systems.
The data from 94 patients with a diagnosis of CCF were collected during a study period 23 years, 4 months. Of these 94 patients, 89 had undergone CCF treatment and 5 had experienced spontaneous occlusion. Complete occlusion was achieved in 89.9% of the treated patients. Complications occurred in 5.3% of the patients, including permanent deficits in 2.1%. TC type 4 was associated with cortical symptoms compared with type 2 (P = 0.003) and type 3 (P < 0.001). The BC was not able to detect significant differences among the symptom types. Significant differences were found using the TC for the transarterial-only, transvenous anterior-only, and transvenous posterior-only approaches (P < 0.001, P = 0.03, and P = 0.001, respectively). The transvenous posterior and transvenous anterior approach were significantly associated with type 2 and 3 TC, respectively. Excluding direct CCFs, the BC was not related to the treatment approach. No significant differences in the outcomes were found. However, a trend toward a lower occlusion rate for TC type 4 compared with type 3 was observed.
The TC provided useful information regarding the fistula anatomy and venous hemodynamics, which correlated with the clinical symptoms and treatment strategy.
已经提出了多种颈动脉海绵窦瘘 (CCF) 分类方法。然而，它们缺乏与临床表现、自然病史和出血风险相关的预测因素。我们的目的是对外科验证一种新的基于静脉引流的分类方法（即托马斯分类 [TC]），以评估其与症状、血管内治疗和结果的关系。
我们对 2 家主要学术机构的 CCF 进行了多中心回顾性研究。使用 Barrow 分类 (BC) 和 TC 系统对 CCF 进行分类。
在 23 年 4 个月的研究期间，共收集了 94 例 CCF 患者的数据。其中 89 例患者接受了 CCF 治疗，5 例患者出现自发性闭塞。接受治疗的患者中 89.9%完全闭塞。5.3%的患者发生并发症，包括 2.1%的永久性损伤。TC 类型 4 与皮质症状相关，与类型 2（P=0.003）和类型 3（P<0.001）相比。BC 无法检测到症状类型之间的显著差异。TC 用于经动脉单纯治疗、经静脉前单纯治疗和经静脉后单纯治疗的方法之间存在显著差异（P<0.001，P=0.03 和 P=0.001）。经静脉后和经静脉前途径与 TC 类型 2 和 3 分别显著相关。排除直接 CCF 后，BC 与治疗方法无关。结果无显著差异。然而，TC 类型 4 的闭塞率与 TC 类型 3 相比呈下降趋势。
TC 提供了有关瘘管解剖结构和静脉血流动力学的有用信息，与临床症状和治疗策略相关。
