后颅窝硬脑膜动静脉瘘的多学科治疗。

Interdisciplinary treatment of posterior fossa dural arteriovenous fistulas.

机构信息

Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA.

Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.

出版信息

Acta Neurochir (Wien). 2021 Sep;163(9):2515-2524. doi: 10.1007/s00701-021-04795-2. Epub 2021 Mar 8.

DOI:10.1007/s00701-021-04795-2

PMID:33683452

Abstract

BACKGROUND

Posterior fossa dural arteriovenous fistulas (dAVFs) are rare vascular lesions with variable risk of hemorrhage, mostly depending on the pattern of the venous drainage. While endovascular embolization is the mainstay treatment for most dAVFs, some posterior fossa lesions require a multidisciplinary approach including surgery. The goal of our study was to examine the outcome of an interdisciplinary treatment for posterior fossa dAVFs.

METHODS

A retrospective review of patients treated for posterior fossa dAVFs was conducted.

RESULTS

A total of 28 patients with a mean age of 57.8 years were included. Patients presented with a Cognard grade I in 2 (7%), II a in 5 (18 %), II b in 7 (25%), II a + b in 5 (18%), III in 3 (11%), and IV in 6 (21%) cases. Hemorrhage was the initial presentation in 2 (22%) patients with Cognard grade IV, in 3 with Cognard grade III (33%), in 1 (11%) with Cognard II a + b, and 3 (33%) with Cognard II b. A complete angiographic cure was achieved in 24 (86%) patients-after a single-session embolization in 16 (57%) patients, multiple embolization sessions in 2 (7%), a multimodal treatment with embolization and surgical disconnection in 3 (11%), and with an upfront surgery in 3 (11%). Complete long-term obliteration was demonstrated in 18/22 (82%) at the mean follow-up of 17 months. Fistulas were converted into asymptomatic Cognard I lesion in 4 (14%) patients.

CONCLUSION

Posterior fossa dAVFs represent a challenging vascular pathology; however, despite their complexity, an interdisciplinary treatment can achieve high rates of angiographic and symptomatic cure with low morbidity and mortality rates. Long-term surveillance is warranted as late recurrences may occur.

摘要

背景

后颅窝硬脑膜动静脉瘘（dAVF）是一种罕见的血管病变，其出血风险各异，主要取决于静脉引流方式。虽然血管内栓塞是大多数 dAVF 的主要治疗方法，但有些后颅窝病变需要包括手术在内的多学科方法。我们的研究目的是检查多学科治疗后颅窝 dAVF 的结果。

方法

对接受后颅窝 dAVF 治疗的患者进行回顾性研究。

结果

共纳入 28 例患者，平均年龄 57.8 岁。患者的 Cognard 分级为 I 级 2 例（7%），IIa 级 5 例（18%），IIb 级 7 例（25%），IIa+b 级 5 例（18%），III 级 3 例（11%），IV 级 6 例（21%）。Cognard 分级 IV 级的 2 例（22%）和 Cognard 分级 III 级的 3 例（33%）患者首发症状为出血，Cognard IIa+b 级的 1 例（11%）和 Cognard IIb 级的 3 例（33%）患者也有出血。24 例（86%）患者完全闭塞治愈，其中 16 例（57%）在单次栓塞后达到完全闭塞，2 例（7%）需多次栓塞，3 例（11%）采用栓塞和手术分离的多模态治疗，3 例（11%）采用初始手术治疗。在平均 17 个月的随访中，18/22 例（82%）患者的瘘管完全闭塞。4 例（14%）患者的瘘管转变成无症状的 Cognard I 病变。