Department of Neurological Surgery (S.M., M.H., Y.Y., K.N., Y. Takahashi, J.H., T.H., T.Y., K.S., I.D.), Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan.
Department of Epidemiology (E.S.), Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan.
Stroke. 2021 Apr;52(4):1455-1459. doi: 10.1161/STROKEAHA.120.032052. Epub 2021 Feb 18.
To date, the incidence of intracranial and spinal arteriovenous shunts has not been thoroughly investigated. We aimed to clarify recent trends in the rates of intracranial and spinal arteriovenous shunts in Japan.
We conducted multicenter hospital-based surveillance at 8 core hospitals in Okayama Prefecture between April 1, 2009 and March 31, 2019. Patients who lived in Okayama and were diagnosed with cerebral arteriovenous malformations, dural arteriovenous fistulas (DAVFs), or spinal arteriovenous shunts (SAVSs) were enrolled. The incidence and temporal trends of each disease were calculated.
Among a total of 393 cranial and spinal arteriovenous shunts, 201 (51.1%) cases of DAVF, 155 (39.4%) cases of cerebral arteriovenous malformation, and 34 (8.7%) cases of SAVS were identified. The crude incidence rates between 2009 and 2019 were 2.040 per 100 000 person-years for all arteriovenous shunts, 0.805 for cerebral arteriovenous malformation, 1.044 for DAVF, and 0.177 for SAVS. The incidence of all types tended to increase over the decade, with a notable increase in incidence starting in 2012. Even after adjusting for population aging, the incidence of nonaggressive DAVF increased 6.0-fold while that of SAVS increased 4.4-fold from 2010 to 2018.
In contrast to previous studies, we found that the incidence of DAVF is higher than that of cerebral arteriovenous malformation. Even after adjusting for population aging, all of the disease types tended to increase in incidence over the last decade, with an especially prominent increase in SAVSs and nonaggressive DAVFs. Various factors including population aging may affect an increase in DAVF and SAVS.
目前，颅内和脊髓动静脉分流的发病率尚未得到充分研究。本研究旨在阐明日本颅内和脊髓动静脉分流的近期发病率趋势。
我们在冈山县的 8 家核心医院进行了多中心基于医院的监测，时间范围为 2009 年 4 月 1 日至 2019 年 3 月 31 日。入组标准为居住在冈山县、诊断为脑动静脉畸形、硬脑膜动静脉瘘（DAVF）或脊髓动静脉分流（SAVS）的患者。计算了每种疾病的发病率和时间趋势。
共发现 393 例颅脊髓动静脉分流患者，其中 DAVF 201 例（51.1%），脑动静脉畸形 155 例（39.4%），SAVS 34 例（8.7%）。2009 年至 2019 年期间所有动静脉分流的粗发病率分别为 2.040/100 000 人年、0.805/100 000 人年、1.044/100 000 人年和 0.177/100 000 人年。10 年来，所有类型的发病率均呈上升趋势，2012 年开始发病率显著上升。即使调整人口老龄化因素，非侵袭性 DAVF 的发病率也从 2010 年到 2018 年增加了 6.0 倍，SAVS 的发病率增加了 4.4 倍。
与既往研究不同，本研究发现 DAVF 的发病率高于脑动静脉畸形。即使调整人口老龄化因素，过去 10 年来所有疾病类型的发病率均呈上升趋势，尤其是 SAVS 和非侵袭性 DAVF 的发病率显著上升。人口老龄化等各种因素可能会影响 DAVF 和 SAVS 的发病率。
