University of Kentucky College of Medicine, Lexington, KY, USA.
Department of Neurosurgery, University of Kentucky, Lexington, KY, USA.
J Stroke Cerebrovasc Dis. 2021 May;30(5):105676. doi: 10.1016/j.jstrokecerebrovasdis.2021.105676. Epub 2021 Feb 25.
Dural arteriovenous fistulae (DAVF) are intracranial vascular abnormalities encountered in neurosurgery practice. Treatment options are microsurgical disconnection, endovascular embolization and/or radiosurgery. Past studies have reported the efficacy, safety, and predictors of success of radiosurgery. In this study, we investigated the angioarchitecture of fistulae at the time of radiosurgery and how the anatomy changed in the time after treatment based on angiogram follow-ups.
A retrospective analysis was performed on patients with angiographic diagnosis of DAVF treated with Gamma Knife radiosurgery (GKRS) between 2013 and 2018. Data collection included demographics, symptoms, grading scores, vascular anatomy, radiation data, treatment strategy, angiographic results, and length of patient follow-up.
Our study reports data on 10 patients with a total of 14 fistulae. On follow-up angiography, 8 (57%) had complete occlusion of the fistula with a median time to follow up of 19.5 months. The remaining 6 (43%) were deemed as near-complete occlusion of fistula with a median time to follow up of 12.0 months. Time from radiosurgery to angiogram revealing incomplete vs. angiogram revealing complete obliteration was significantly different (p=0.045). Nearly all AVFs had decreased feeders over time after treatment with only one AVF developing an additional feeder post-treatment. Arterial feeders, drainage site, sex, Borden type, lesion volume and treatment volume had no predictive value of obliteration outcome.
This study provides data on the angioarchitecture of fistulae treated with GKRS and also serves as an extension of previous studies reporting the safety and efficacy of GKRS treatment for DAVF in a specific patient population.
硬脑膜动静脉瘘（DAVF）是神经外科实践中遇到的颅内血管异常。治疗选择包括显微手术切断、血管内栓塞和/或放射外科治疗。过去的研究报告了放射外科治疗的疗效、安全性和成功预测因素。在这项研究中，我们调查了放射外科时瘘管的血管结构，并根据血管造影随访，研究了治疗后血管结构的变化。
对 2013 年至 2018 年间接受伽玛刀放射外科（GKRS）治疗的 DAVF 患者进行回顾性分析。数据收集包括人口统计学、症状、分级评分、血管解剖、放射数据、治疗策略、血管造影结果和患者随访时间。
我们的研究报告了 10 例患者共 14 个瘘管的数据。在随访血管造影中，8 例（57%）瘘管完全闭塞，中位随访时间为 19.5 个月。其余 6 例（43%）被认为是瘘管接近完全闭塞，中位随访时间为 12.0 个月。从放射外科到血管造影显示不完全闭塞与显示完全闭塞的时间明显不同（p=0.045）。几乎所有的动静脉瘘在治疗后随着时间的推移，其供血动脉都会减少，只有一例动静脉瘘在治疗后出现了新的供血动脉。动脉供血动脉、引流部位、性别、Borden 类型、病变体积和治疗体积对闭塞结果均无预测价值。
本研究提供了 GKRS 治疗瘘管的血管结构数据，也是对以前研究的扩展，这些研究报告了 GKRS 治疗特定患者人群的 DAVF 的安全性和疗效。
