Wen Hung-Yu, Chen Hsien-Chung, Yang Shun-Tai
Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan.
Taipei Neuroscience Institute, Taipei Medical University, New Taipei City 235041, Taiwan.
J Clin Med. 2021 Dec 13;10(24):5835. doi: 10.3390/jcm10245835.
Compared to nonaggressive cranial dural arteriovenous fistulae (cDAVF), aggressive cDAVF carries leptomeningeal venous drainage (LVD) and has approximately 15% annual risk of hemorrhagic and non-hemorrhagic aggressive neurological presentations. In terms of aggressive clinical presentations, the previous classification does not adequately differentiate the higher risk group from the lower risk group. Herein, we retrospectively collected a series of patients with aggressive cDAVF and explored the risk factors for differentiating the higher-risk group from the lower-risk group with aggressive clinical presentations. We retrospectively collected patients with aggressive cDAVF from March 2011 to March 2019. The risk of aggressive clinical presentation was recorded. Risk factors were included in the analysis for aggressive clinical presentations. From March 2011 to March 2019, 37 patients had aggressive cDAVF. Among them, 24 presented with aggressive clinical presentation (20, hemorrhagic presentation; four, non-hemorrhagic presentation). In patients presenting with hemorrhage, four patients experienced early rebleeding after diagnosis. In the univariate analysis, risk location, directness of LVD, exclusiveness of LVD, and venous strain were significantly different in patients with aggressive clinical presentation. In the multivariate analysis, exclusiveness of LVD and venous strain were observed, with a significant difference between patients with aggressive clinical presentation and those with benign clinical presentation. Among patients with angiographically aggressive cDAVFs, approximately 65% presented with aggressive clinical presentations in our series. Among all potential risk factors, patients with exclusiveness of LVD and venous strain have even higher risk and should be treated aggressively and urgently.
与非侵袭性颅内硬脑膜动静脉瘘（cDAVF）相比，侵袭性cDAVF存在软脑膜静脉引流（LVD），每年有大约15%的出血性和非出血性侵袭性神经症状风险。在侵袭性临床表现方面，先前的分类未能充分区分高风险组和低风险组。在此，我们回顾性收集了一系列侵袭性cDAVF患者，并探讨了区分具有侵袭性临床表现的高风险组和低风险组的危险因素。我们回顾性收集了2011年3月至2019年3月期间患有侵袭性cDAVF的患者。记录侵袭性临床表现的风险。将危险因素纳入侵袭性临床表现的分析中。2011年3月至2019年3月，37例患者患有侵袭性cDAVF。其中，24例表现出侵袭性临床表现（20例为出血性表现；4例为非出血性表现）。在出血患者中，4例患者在诊断后出现早期再出血。单因素分析显示，侵袭性临床表现患者的风险位置、LVD的直接性、LVD的排他性和静脉张力存在显著差异。多因素分析中，观察到LVD的排他性和静脉张力，侵袭性临床表现患者与良性临床表现患者之间存在显著差异。在血管造影显示为侵袭性cDAVF的患者中，在我们的系列中约65%表现出侵袭性临床表现。在所有潜在危险因素中，LVD排他性和静脉张力患者的风险更高，应积极紧急治疗。
