回顾性研究 78 例成人天幕中线区域硬脑膜动静脉瘘。
A retrospective study of 78 adult tentorial middle line region dural arteriovenous fistulae.
机构信息
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.
出版信息
Acta Neurol Belg. 2023 Aug;123(4):1395-1404. doi: 10.1007/s13760-023-02237-7. Epub 2023 Mar 28.
OBJECTIVE
Dural arteriovenous fistulae (DAVF) in the tentorial middle line region are uncommon with specific features and more cognitive disorders than any other region. The purpose of this study is to present clinical characteristics and our experience with endovascular treatment in this specific region.
METHODS
During a 20-year period, 94.9% of patients (74/78) underwent endovascular treatment (36 in galenic, 48.6%) (12 in straight sinus, 16.2%) (26 in torcular, 35.1%). There were 63 males and 15 females with mean age of 50 (50 ± 12) years in total of 78 patients. The clinical presentation, angiographic features, treatment strategy, and clinical outcomes were recorded.
RESULTS
Transarterial embolization (TAE) was performed in 89.2% of the 74 patients (66/74), transvenous embolization alone in one patient and mixed approach in seven. Complete obliteration of the fistulas was obtained in 87.5% of the patients (64/74). 71 patients (mean, 56 months) had phone, outpatient, or admission follow-up. The digital subtraction angiography (DSA) follow-up period (25/78, 32.1%) was 13.8 (6-21) months. Two of them (2/25, 8%) had fistula recurrences after complete embolization and were embolized again. The phone follow-up period (70/78, 89.7%) was 76.6 (40-92.3) months. Pre-embolization and post-embolization mRS ≥ 2 were in 44 patients (44/78) and 15 (15/71) patients, respectively. DAVF with internal cerebral vein drainage (OR 6.514, 95% Cl 1.201-35.317) and intracranial hemorrhage (OR 17.034, 95% Cl 1.122-258.612) during TAE were the risk factors for predicting poor outcomes (followed up mRS ≥ 2).
CONCLUSIONS
TAE is the first-line treatment for tentorial middle line region DAVF. When pial feeders' obliteration is difficult to achieve, it should not be forced due to the poor outcomes after intracranial hemorrhage. The cognitive disorders caused by this region were not reversible as reported. It is imperative to enhance the care provided to these patients with cognitive disorders.
目的
天幕正中部位的硬脑膜动静脉瘘（DAVF）较为少见，其临床特征和认知障碍比其他部位更为明显。本研究旨在介绍该特定部位的血管内治疗的临床特征和我们的经验。
方法
在 20 年期间，94.9%的患者（78 例中的 74 例）接受了血管内治疗（36 例岩上窦，48.6%）（12 例直窦，16.2%）（26 例横窦，35.1%）。78 例患者中有 63 例男性和 15 例女性，平均年龄为 50（50±12）岁。记录了临床症状、血管造影特征、治疗策略和临床结果。
结果
74 例患者中有 89.2%（66/74）接受了经动脉栓塞治疗（TAE），1 例仅接受了经静脉栓塞治疗，7 例接受了混合治疗。87.5%的患者（64/74）达到了瘘管完全闭塞。71 例患者（平均随访时间 56 个月）接受了电话、门诊或住院随访。78 例患者中的 25 例（25/78，32.1%）进行了数字减影血管造影（DSA）随访，随访时间为 13.8（6-21）个月。其中 2 例（2/25，8%）在完全栓塞后出现瘘管复发，再次进行了栓塞。78 例患者中的 70 例（70/78，89.7%）进行了电话随访，随访时间为 76.6（40-92.3）个月。栓塞前和栓塞后 mRS≥2 的患者分别为 44 例（44/78）和 15 例（15/71）。在 TAE 期间，存在大脑内静脉引流（OR 6.514，95%CI 1.201-35.317）和颅内出血（OR 17.034，95%CI 1.122-258.612）是预测不良结局（随访 mRS≥2）的危险因素。
结论
TAE 是天幕正中部位 DAVF 的一线治疗方法。当难以实现软脑膜供血动脉闭塞时，由于颅内出血后预后较差，不应强行进行。该部位引起的认知障碍如报道的那样是不可逆转的。必须加强对这些有认知障碍的患者的护理。
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