CT 引导下纤维蛋白胶封堵脑脊髓液-静脉瘘后头痛的反应。

Headache response after CT-guided fibrin glue occlusion of CSF-venous fistulas.

机构信息

Department of Radiology, The Permanente Medical Group, Kaiser Permanente Medical Center, Santa Clara, California, USA.

Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.

出版信息

Headache. 2022 Sep;62(8):1007-1018. doi: 10.1111/head.14379. Epub 2022 Aug 26.

DOI:10.1111/head.14379

PMID:36018057

Abstract

OBJECTIVE

To assess headache response and patient perception of improvement after computed tomography (CT)-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas (CVFs) in a large sample size and with a long clinical follow-up.

BACKGROUND

CVFs are an increasingly identified type of spinal leak in patients with spontaneous intracranial hypotension (SIH), and CT-guided fibrin glue occlusion has been introduced as a treatment option in a prior small series.

METHODS

Retrospective case series review of medical records from a single institution was performed for all patients with CVFs that were treated with CT-guided fibrin glue occlusion between August 2018 and April 2022 in an outpatient or inpatient setting. Pre- and posttreatment Headache Impact Tests (HIT-6) were administered to patients, and a change in scores was evaluated. In some patients, pretreatment HIT-6 tests were not obtained prior to the fibrin glue procedure, and the patient was asked to fill out the pretreatment test based on personal recall of their symptoms prior to treatment. Patients completed a Patient Global Impression of Change (PGIC) scale after treatment. Pre- and posttreatment brain imaging was compared using Bern SIH scores.

RESULTS

Thirty-five patients (19 females, 16 males; mean age 60 years) with CVFs treated with CT-guided fibrin glue occlusion met the inclusion criteria. Mean pretreatment and posttreatment HIT-6 scores were 64.7 ± 10.2 and 43.4 ± 9.9 (p < 0.001), respectively. The posttreatment HIT-6 questionnaires were completed on average 10.3 months after treatment, and 20 patients filled out the pretreatment HIT-6 form after their treatment. The mean PGIC score was 6.1 ± 1.3. Mean pretreatment and posttreatment Bern SIH scores were 5.9 ± 2.5 and 1.5 ± 1.5 (p < 0.001), respectively.

CONCLUSIONS

We report a large series of patients who underwent CT-guided fibrin glue occlusion of CVFs. We showed that headache scores decreased after treatment, and the majority of patients had high PGIC scores. Posttreatment brain MRIs also showed improved Bern SIH scores.

摘要

目的

评估在大样本量和长期临床随访下，经计算机断层扫描（CT）引导纤维蛋白胶闭塞脑脊髓液-静脉瘘（CVF）后头痛反应和患者对改善的感知。

背景

CVF 是自发性颅内低血压（SIH）患者中越来越多的脊髓漏类型，CT 引导纤维蛋白胶闭塞已在先前的小系列中被引入作为一种治疗选择。

方法

对 2018 年 8 月至 2022 年 4 月期间在门诊或住院环境下接受 CT 引导纤维蛋白胶闭塞治疗的所有 CVF 患者的病历进行回顾性病例系列研究。在治疗前后向患者提供头痛影响测试（HIT-6），并评估评分变化。在某些患者中，纤维蛋白胶治疗前未获得治疗前 HIT-6 测试，患者根据治疗前症状的个人回忆填写治疗前测试。治疗后，患者完成患者整体印象变化（PGIC）量表。使用 Bern SIH 评分比较治疗前后的脑部影像学检查。

结果

35 例（19 名女性，16 名男性；平均年龄 60 岁）CVF 患者符合纳入标准，经 CT 引导纤维蛋白胶闭塞治疗。平均治疗前和治疗后 HIT-6 评分分别为 64.7±10.2 和 43.4±9.9（p<0.001）。治疗后平均 10.3 个月完成 HIT-6 问卷，20 例患者在治疗后填写 HIT-6 问卷。平均 PGIC 评分为 6.1±1.3。平均治疗前和治疗后 Bern SIH 评分分别为 5.9±2.5 和 1.5±1.5（p<0.001）。