Deniwar Mohamed Adel, Ahmad Saima, Eldin Ashraf Ezz
Department of Neurosurgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
Department of Diagnostic and Interventional Neuroradiology, Lahore General Hospital, Post Graduate Medical Institute, Ameer-ud-Din Medical College, Lahore, Pakistan.
J Korean Neurosurg Soc. 2022 Jan;65(1):30-39. doi: 10.3340/jkns.2021.0116. Epub 2021 Dec 13.
There are different types of cerebral vascular malformations. Pial arteriovenous fistulas (PAVFs) and dural arteriovenous fistulas (DAVFs) are two entities; they consist of one or more arterial connections to a single venous outlet without a true intervening nidus. The high turbulent flow of PAVFs and aggressive DAVFs with cortical venous reflux can result in venous outflow varix and aneurysmal dilatation. They pose a significant challenge to transvenous embolization (TVE), stereotactic radiosurgery, and surgical treatment. We aim to share our centers' experience with the transarterial embolization (TAE) for arteriovenous fistulas (AVFs) with large venous pouches and to report the outcome.
The authors' two institutions' databases were retrospectively reviewed from February 2017 to February 2021. All patients with intracranial high flow PAVFs and aggressive DAVFs with venous outlet ectasia and large venous varix and were treated by TAE were included.
Fifteen patients harboring 11 DAVFs and four PAVFs met our inclusion criteria. All patients underwent TAE in 17 sessions. Complete angiographic obliteration was achieved after 14 sessions in 12 patients (80%). Four patients (25%) had residual after one TAE session. Technical failure was documented in one patient (6.7%). Fourteen patients (93.3%) had favorable functional outcome (modified Rankin score 0-2).
TAE for high flow or aggressive intracranial AVFs is a safe and considerable treatment option, especially for those associated with large venous pouches that are challenging and relatively high-risk for TVE.
脑血管畸形有不同类型。软膜动静脉瘘（PAVF）和硬脑膜动静脉瘘（DAVF）是两种类型；它们由一个或多个与单一静脉出口的动脉连接组成，没有真正的中间瘤巢。PAVF的高湍流以及伴有皮质静脉回流的侵袭性DAVF可导致静脉流出静脉曲张和动脉瘤样扩张。它们对经静脉栓塞术（TVE）、立体定向放射外科和手术治疗构成重大挑战。我们旨在分享我们中心对伴有大静脉囊袋的动静脉瘘（AVF）进行经动脉栓塞术（TAE）的经验并报告结果。
回顾性分析作者所在两个机构2017年2月至2021年2月的数据库。纳入所有患有颅内高流量PAVF和伴有静脉出口扩张及大静脉静脉曲张的侵袭性DAVF并接受TAE治疗的患者。
15例患者（11例DAVF和4例PAVF）符合我们的纳入标准。所有患者共接受了17次TAE治疗。12例患者（80%）在14次治疗后实现了血管造影完全闭塞。4例患者（25%）在一次TAE治疗后有残留。1例患者（6.7%）记录有技术失败。14例患者（93.3%）获得了良好的功能结局（改良Rankin评分0 - 2）。
对于高流量或侵袭性颅内AVF，TAE是一种安全且值得考虑的治疗选择，尤其是对于那些伴有大静脉囊袋且对TVE具有挑战性和相对高风险的患者。
