Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Division of Neurosurgery, Ospedale Civile di Legnano, ASST Ovest Milano, Milan, Italy.
Acta Neurochir Suppl. 2021;132:113-122. doi: 10.1007/978-3-030-63453-7_17.
Dural arteriovenous fistulas (dAVFs) account for 10-15% of all intracranial arteriovenous lesions. Different classification strategies have been proposed in the course of the years. None of them seems to guide the treatment strategy.
We expose the experience of the vascular group at Niguarda Hospital and we propose a very practical classification method based on the location of the shunt. We divide dAVF in sinus and non-sinus in order to simplify our daily practice, as this classification method is simply based on the involvement of the sinuses.
477 intracranial dural arteriovenous fistulas have been treated. 376 underwent endovascular treatment and 101 underwent surgical treatment. Cavernous sinus DAVFs and Galen ampulla malformations have been excluded from this series as they represent a different pathology per se. 376 dAVFs treated by endovascular approach: 180 were sinus and 179 were non-sinus. 101 dAVFs treated with surgical approach: 15 were sinus and 86 were non-sinus.
Of the 477 intracranial dAVF the recorded mortality and severe disability was 3% and morbidity less than 4%. All patients underwent a postoperative DSA with nearly 100% of complete occlusion of the fistula. At a mean follow-up of 5 years in one case there was a non-sinus fistula recurrence, due to the presence of a partial clipping of "piè" of the vein.
The sinus and non-sinus concept has guided our institution for years and has led to good clinical results. This paper intends to share this practical classification with the neurosurgical community.
硬脑膜动静脉瘘（dAVF）占所有颅内动静脉病变的 10-15%。多年来提出了不同的分类策略。但它们似乎都不能指导治疗策略。
我们展示了 Niguarda 医院血管组的经验，并提出了一种基于分流位置的非常实用的分类方法。我们将 dAVF 分为窦内和窦外，以便简化我们的日常实践，因为这种分类方法简单地基于窦的受累情况。
共治疗了 477 例颅内硬脑膜动静脉瘘。376 例采用血管内治疗，101 例采用手术治疗。海绵窦 dAVF 和 Galen 壶腹畸形已被排除在本系列之外，因为它们本身代表了不同的病理学。376 例经血管内治疗的 dAVF：180 例为窦内，179 例为窦外。101 例经手术治疗的 dAVF：15 例为窦内，86 例为窦外。
在 477 例颅内 dAVF 中，记录的死亡率和严重残疾为 3%，发病率低于 4%。所有患者均接受了术后 DSA 检查，瘘管几乎 100%完全闭塞。在平均 5 年的随访中，1 例非窦内瘘复发，原因是静脉“piè”的部分夹闭。
窦内和窦外的概念多年来一直指导着我们的机构，并取得了良好的临床效果。本文旨在与神经外科学界分享这种实用的分类方法。
