Hou Kun, Xu Kan, Qu Lai, Li Guichen, Guo Yunbao, Yu Jinlu
Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.
Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, China.
Front Neurol. 2021 Jan 20;11:603256. doi: 10.3389/fneur.2020.603256. eCollection 2020.
In rare circumstances, brain arteriovenous malformations (BAVMs) can recruit a transdural blood supply (TBS). The clinical and radiologic characteristics of BAVMs with a TBS are poorly understood. A retrospective review of the medical records was conducted for adult patients who were admitted for BAVMs from Jan 2013 to Dec 2019. TBSs for BAVMs were divided into 3 types: (1) unilateral TBSs from the external carotid artery (ECA) and/or meningeal branch of the vertebral artery (VA); (2) bilateral TBSs from the ECA and/or meningeal branch of the VA; and (3) meningohypophyseal trunk TBSs of the internal carotid artery. Four hundred and twenty-eight patients were diagnosed with BAVMs during the study period, of whom 30 (7.0%, 30/428) were identified as having a TBS. Type 1, type 2, and type 3 TBSs were identified in 21 (70%, 21/30), 7 (23.3%, 7/30), and 2 (6.7%, 2/30) patients, respectively. Six (20%, 6/30) patients were conservatively managed. Twelve (40%, 12/30) patients underwent endovascular treatment (EVT) of the BAVM through non-TBS feeders. Eight (26.8%, 8/30) patients underwent EVT of the BAVM both through the TBS and non-TBS feeders. The modified Rankin Scale scores at the 3-month follow-up were 0, 1, 2, 4, and 5 in 24 (80%, 24/30), 2 (6.7%, 2/30), 2 (6.7%, 2/30), 1 (3.3%, 1/30), and 1 (3.3%, 1/30) patients, respectively. Good short-term recovery was achieved in 86.7% (26/30) of the patients. The size of the BAVMs with a TBS was larger than that of BAVMs without a TBS. Patients with higher Spetzler-Martin grades tended to have a TBS. No statistical difference was noted between the patients with and without a TBS with regard to age, sex, location, or concurrent aneurysms. This study showed that a TBS was likely to develop in patients with larger BAVMs and that a TBS was likely to be located in the temporal lobe in patients BAVMs with higher SM grades. Weak structures were the primary targets of management. In addition, a BAVM could be embolized via the TBS.
在罕见情况下，脑动静脉畸形（BAVMs）可获得经硬脑膜供血（TBS）。目前对伴有TBS的BAVMs的临床和影像学特征了解甚少。对2013年1月至2019年12月因BAVMs入院的成年患者的病历进行了回顾性研究。BAVMs的TBS分为3种类型：（1）来自颈外动脉（ECA）和/或椎动脉（VA）脑膜支的单侧TBS；（2）来自ECA和/或VA脑膜支的双侧TBS；（3）颈内动脉脑膜垂体干TBS。在研究期间，428例患者被诊断为BAVMs，其中30例（7.0%，30/428）被确定有TBS。分别在21例（70%，21/30）、7例（23.3%，7/30）和2例（6.7%，2/30）患者中发现1型、2型和3型TBS。6例（20%，6/30）患者接受保守治疗。12例（40%，12/30）患者通过非TBS供血支对BAVMs进行了血管内治疗（EVT）。8例（26.8%，8/30）患者通过TBS和非TBS供血支对BAVMs均进行了EVT。在3个月随访时，改良Rankin量表评分在24例（80%，24/30）、2例（6.7%，2/30）、2例（6.7%，2/30）、1例（3.3%，1/30）和1例（3.3%，1/30）患者中分别为0、1、2、4和5。86.7%（26/30）的患者实现了良好的短期恢复。伴有TBS的BAVMs的大小大于不伴有TBS的BAVMs。Spetzler-Martin分级较高的患者往往有TBS。在年龄、性别、位置或合并动脉瘤方面，有TBS和无TBS的患者之间未发现统计学差异。本研究表明，较大的BAVMs患者可能出现TBS，且在Spetzler-Martin分级较高的BAVMs患者中，TBS可能位于颞叶。薄弱结构是治疗的主要靶点。此外，BAVM可通过TBS进行栓塞。
