Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
World Neurosurg. 2022 Nov;167:e397-e405. doi: 10.1016/j.wneu.2022.08.021. Epub 2022 Aug 11.
To explore the impact of outflow patency on radiosurgical outcomes of lateral sinus dural arteriovenous fistulas (DAVFs).
We retrospectively examined 83 lateral sinus DAVFs treated with Gamma Knife radiosurgery (GKRS) between 1995 and 2020. Two neuroradiologists blinded to the therapeutic outcomes served as imaging evaluators on pre-GKRS digital subtraction angiography and magnetic resonance images. The sinovenous outflow of lateral sinus DAVF was scored using combined conduit score (CCS), ranging from 0 (total occlusion) to 8 (full patency). The patients' follow-up magnetic resonance and digital subtraction angiography images were used to validate the radiosurgical outcomes (obliteration or non-obliteration) of lateral sinus DAVF. Cox regression and Kaplan-Meier analyses were performed to determine the correlations between the variables and outcomes.
Among the 83 cases, 60 (72%) lateral sinus DAVFs achieved obliteration after a GKRS at a median latency period of 24.5 months. After adjustment for aggressive presentation, cortical venous reflux, straight sinus reflux, and optic nerve sheath enlargement, a CCS of >6 was independently associated with lateral sinus DAVF obliteration (hazard ratio: 2.335, P = 0.007). The estimated 36-month probabilities of obliteration were 80% versus 53.6% for lateral sinus DAVFs with a CCS of >6 versus ≤6.
Lateral sinus DAVFs with a CCS of >6, indicating a nearly patent sinovenous outflow, were more likely to be obliterated after GKRS. Sinovenous outflow patency is a factor associated with therapeutic outcomes in radiosurgery for lateral sinus DAVFs.
探讨外侧窦硬脑膜动静脉瘘（DAVF）流出道通畅性对伽玛刀放射外科治疗结局的影响。
我们回顾性分析了 1995 年至 2020 年间接受伽玛刀放射外科治疗的 83 例外侧窦 DAVF。两名对治疗结果不知情的神经放射科医生作为影像评估员，对伽玛刀放射外科治疗前的数字减影血管造影和磁共振成像进行评估。采用联合管腔评分（CCS）对外侧窦 DAVF 的窦静脉流出道进行评分，范围从 0（完全闭塞）到 8（完全通畅）。根据患者的随访磁共振和数字减影血管造影图像，验证外侧窦 DAVF 的放射外科治疗结局（闭塞或未闭塞）。采用 Cox 回归和 Kaplan-Meier 分析确定变量与结局之间的相关性。
在 83 例病例中，60 例（72%）外侧窦 DAVF 在伽玛刀放射外科治疗后 24.5 个月达到闭塞。在调整侵袭性表现、皮质静脉反流、直窦反流和视神经鞘扩张等因素后，CCS>6 与外侧窦 DAVF 闭塞独立相关（危险比：2.335，P=0.007）。CCS>6 与 CCS≤6 的外侧窦 DAVF 的 36 个月闭塞概率分别为 80%和 53.6%。
CCS>6 提示窦静脉流出道几乎通畅的外侧窦 DAVF 在接受伽玛刀放射外科治疗后更有可能闭塞。窦静脉流出道通畅性是影响外侧窦 DAVF 放射外科治疗结局的一个因素。
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