1Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo.
2Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi.
J Neurosurg. 2022 Apr 29;137(6):1776-1785. doi: 10.3171/2022.3.JNS22341. Print 2022 Dec 1.
A recent comparative analysis between neurosurgical and endovascular treatments for craniocervical junction (CCJ) arteriovenous fistulas (AVFs) revealed better treatment outcomes in the neurosurgery group than in the endovascular group. This finding was attributed to the higher than expected rate of ischemic complications in the endovascular group than in the neurosurgery group (26% vs 7.7%, p = 0.037). The aim of the present study was to describe ischemic complications associated with treatments for CCJ AVFs.
This descriptive study was authorized by the Neurospinal Society of Japan. Data from 97 consecutive patients with CCJ AVFs who underwent neurosurgical (n = 78) or endovascular (n = 19) treatment between 2009 and 2019 were collected from 29 centers. The primary endpoints were details on ischemic complications and their risk factors. Secondary endpoints were details on other complications.
Among all major complications, ischemic complications were the most common (11% of 97 patients), followed by hemorrhagic complications (7.2%), hydrocephalus (2.1%), and CSF leakage (2.1%). Ischemic complications included 8 spinal, 2 brainstem, and 1 cerebellar infarctions. Iatrogenic occlusion of the anterior or posterior spinal artery from the radiculomedullary or radiculopial arteries caused these complications. Ischemic complications resulted in neurological deficits, including motor paresis, sensory disturbances, and brainstem dysfunction. The modified Rankin Scale score was 3 or higher in 36% of patients with ischemic complications at the final follow-up of 23 months. Risk factors associated with ischemic complications were endovascular treatment (OR 4.3, 95% CI 1.1-16) and spinal feeding arteries (OR 3.8, 95% CI 1.03-14). Most of the other complications were addressed by additional treatment without permanent neurological deficits.
Among ischemic complications associated with treatments for CCJ AVFs, spinal infarctions were the most common and were mostly attributed to endovascular procedures for CCJ AVFs fed by spinal arteries. These results support the use of neurosurgery as the first-line treatment for CCJ AVFs.
最近一项对颅颈交界区（CCJ）动静脉瘘（AVF）的神经外科和血管内治疗进行的对比分析显示，神经外科组的治疗效果优于血管内组。这一发现归因于血管内组比神经外科组出现缺血性并发症的比率更高（26%比 7.7%，p=0.037）。本研究旨在描述与 CCJ AVF 治疗相关的缺血性并发症。
本描述性研究得到日本神经脊柱学会的授权。从 2009 年至 2019 年期间，29 个中心共收集了 97 例连续接受 CCJ AVF 神经外科（n=78）或血管内（n=19）治疗的患者数据。主要终点是缺血性并发症的详细信息及其危险因素。次要终点是其他并发症的详细信息。
在所有主要并发症中，缺血性并发症最常见（97 例患者中的 11%），其次是出血性并发症（7.2%）、脑积水（2.1%）和脑脊液漏（2.1%）。缺血性并发症包括 8 例脊髓梗死、2 例脑梗死和 1 例小脑梗死。神经根髓质或神经根舌下动脉引起的脊髓前或后动脉医源性闭塞导致了这些并发症。缺血性并发症导致了神经功能缺损，包括运动麻痹、感觉障碍和脑干功能障碍。在最终 23 个月的随访中，缺血性并发症患者中有 36%的改良 Rankin 量表评分≥3。与缺血性并发症相关的危险因素是血管内治疗（OR 4.3，95%CI 1.1-16）和脊髓供血动脉（OR 3.8，95%CI 1.03-14）。大多数其他并发症通过额外的治疗得到解决，没有永久性的神经功能缺损。
在与 CCJ AVF 治疗相关的缺血性并发症中，脊髓梗死最常见，主要归因于血管内治疗 CCJ AVF 时脊髓动脉供血。这些结果支持将神经外科作为 CCJ AVF 的一线治疗方法。
