硬脑膜脑动静脉畸形的特点，伴硬脑膜动脉供血。
Characteristics of pial brain arteriovenous malformations with transdural arterial supply.
机构信息
Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
出版信息
Eur J Radiol. 2021 Jun;139:109670. doi: 10.1016/j.ejrad.2021.109670. Epub 2021 Apr 8.
PURPOSE
Transdural blood supply (TDBS) to pial brain arteriovenous malformations (BAVM) is uncommon and believed to be related to vascular endothelial growth factor - induced angiogenesis. The aim of this study was to define the BAVM characteristics in relation to presence and volume of TDBS.
METHODS
BAVMs managed at our institution between January 2006 and December 2016 who subsequently underwent complete digital subtraction angiography (DSA) were included. They were classified based on presence of TDBS as well as volume of TDBS.
RESULTS
Of the 641 BAVM patients managed during the recruitment period, 387 (391 BAVMs) had complete pretreatment DSAs. Forty-three (11.0 %, 10 ruptured) BAVMs exhibited TDBS. With TDBS group had a significantly greater proportion of large nidus (> 3.1 cm) than the Without TDBS group (85.1 % vs 19.5 %, p < 0.01) and were more frequently temporal (32.6 % vs 14.7 %, p < 0.01) and occipital (25.6 % vs 13.5 %, p < 0.05) in location. In unruptured BAVMs, the presence of headaches was significantly more prevalent when the malformation harboured TDBS compared to not (57.6 vs 34.8 %, p < 0.05). The annual rupture rate among unruptured BAVMs treated by conservative management was 4.7 % in the With TDBS (n = 12) group and 0% (n = 21) in BAVMs with TDBS that underwent treatment including surgery, endovascular therapy, or radiosurgery.
CONCLUSION
BAVMs with TDBS are more likely to be associated with a large nidus and located in the temporal and occipital lobes. Headache is more frequently associated with the presence of TDBS. Rupture rate of unruptured BAVMS with TDBS can be effectively reduced following treatment.
目的
硬脑膜外血供（TDBS）向脑动静脉畸形（BAVM）并不常见，据信与血管内皮生长因子诱导的血管生成有关。本研究旨在确定与 TDBS 存在和体积相关的 BAVM 特征。
方法
纳入 2006 年 1 月至 2016 年 12 月在我院接受治疗的 BAVM 患者，所有患者均接受了全数字化减影血管造影（DSA）检查。根据 TDBS 的存在和 TDBS 的体积对患者进行分类。
结果
在招募期间，共有 641 例 BAVM 患者接受了治疗，其中 387 例（391 个 BAVM）接受了完整的术前 DSA 检查。43 例（11.0%，10 例破裂）BAVM 显示有 TDBS。TDBS 组大病灶（>3.1cm）比例明显高于无 TDBS 组（85.1%比 19.5%，p<0.01），颞叶（32.6%比 14.7%，p<0.01）和枕叶（25.6%比 13.5%，p<0.05）位置更为常见。在未破裂的 BAVM 中，当畸形存在 TDBS 时，头痛的发生率明显高于不存在 TDBS 时（57.6%比 34.8%，p<0.05）。接受保守治疗的未破裂 BAVM 中，TDBS 组（n=12）的年破裂率为 4.7%，而接受手术、血管内治疗或放射外科治疗等治疗的 BAVM 组（n=21）无破裂。
结论
有 TDBS 的 BAVM 更有可能与大病灶相关，位于颞叶和枕叶。头痛与 TDBS 的存在更为相关。TDBS 存在的未破裂 BAVM 的破裂率可通过治疗有效降低。
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