Song Zihao, Ma Yongjie, Wang Yinqing, He Chuan, Li Guilin, Zhang Peng, Hong Tao, Sun Liyong, Hu Peng, Ye Ming, Zhang Hongqi
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
China International Neuroscience Institute (China-INI), Beijing, China.
Front Surg. 2023 Jan 6;9:1076549. doi: 10.3389/fsurg.2022.1076549. eCollection 2022.
Arteriovenous fistulas (AVFs) in the craniocervical junction (CCJ) region are a rare occurrence with special clinical manifestations. This study retrospectively reviewed patients with CCJ AVFs treated at our neurosurgical center, aiming to enhance the understanding of CCJ AVFs.
A total of 113 patients with CCJ AVFs treated at our neurosurgical center between January 2013 and December 2020 were enrolled. They were grouped as patients with CCJ AVFs with spinal arterial feeders ( = 20) and patients with CCJ AVF without spinal arterial feeders ( = 93). Clinical presentation, angiographic characteristics, intraoperative findings, and treatment outcomes were analyzed.
The patients' median age was 55 years (IQR 47.5-62 years). The proportion of males in the group without spinal arterial feeders was significantly higher ( = 0.001). Subarachnoid hemorrhage (SAH) was the most common clinical presentation, especially in the group with spinal arterial feeders ( < 0.001). There were significant differences in AVF type, fistula location, and direction of the venous drainage between the two groups ( < 0.001). Intervention embolization combined with microsurgery was more common in treating AVFs with spinal arterial feeders ( = 0.006). Spinal arterial feeders did not affect the outcome ( = 0.275).
SAH was the most common presentation of CCJ AVFs in this study. Microsurgery and interventional embolization were optional treatment strategies. The angioarchitecture of CCJ AVFs was essential for selecting treatment strategies.
颅颈交界区（CCJ）的动静脉瘘（AVF）较为罕见，具有特殊的临床表现。本研究回顾性分析了在我们神经外科中心接受治疗的CCJ AVF患者，旨在加深对CCJ AVF的认识。
纳入2013年1月至2020年12月在我们神经外科中心接受治疗的113例CCJ AVF患者。他们被分为有脊髓动脉供血的CCJ AVF患者（n = 20）和无脊髓动脉供血的CCJ AVF患者（n = 93）。分析临床表现、血管造影特征、术中发现及治疗结果。
患者的中位年龄为55岁（四分位间距47.5 - 62岁）。无脊髓动脉供血组男性比例显著更高（P = 0.001）。蛛网膜下腔出血（SAH）是最常见的临床表现，尤其是在有脊髓动脉供血的组中（P < 0.001）。两组在AVF类型、瘘口位置及静脉引流方向上存在显著差异（P < 0.001）。介入栓塞联合显微手术在治疗有脊髓动脉供血的AVF中更为常见（P = 0.006）。脊髓动脉供血不影响预后（P = 0.275）。
SAH是本研究中CCJ AVF最常见的表现。显微手术和介入栓塞是可选的治疗策略。CCJ AVF的血管结构对选择治疗策略至关重要。
