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颅颈交界区高位颈动静脉瘘的治疗

Treatment of high cervical arteriovenous fistulas in the craniocervical junction region.

作者信息

Su Han, Yu Jinlu

机构信息

Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.

出版信息

Front Neurol. 2023 Jun 27;14:1164548. doi: 10.3389/fneur.2023.1164548. eCollection 2023.

DOI:10.3389/fneur.2023.1164548
PMID:37441609
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10335834/
Abstract

The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.

摘要

颅颈交界区（CCJ）是一个复杂的区域。动静脉瘘（AVF）很少发生在CCJ区域。目前，人们认为CCJ AVF仅指C1 - C2水平的AVF。在讨论CCJ AVF时，提及高位颈段CCJ AVF是合理的。高位颈段CCJ AVF可分为以下四种类型：硬脑膜AVF、神经根性AVF、硬膜外AVF和髓周AVF。到目前为止，理解高位颈段CCJ AVF并为其提供恰当的治疗很困难。因此，有必要对高位颈段CCJ AVF进行更新的综述。在这篇综述中，讨论了以下问题：高位颈段CCJ AVF的定义、CCJ区域的血管解剖、高位颈段CCJ AVF的血管构筑、治疗选择、预后和并发症。基于该综述及我们的经验，我们发现四种类型的高位颈段CCJ AVF具有相似的临床和影像学特征。患者可能出现颅内出血或充血性脊髓病。治疗方法包括开放手术和血管内治疗（EVT），可用于有症状的AVF。大多数高位颈段CCJ AVF可通过开放手术有效治疗。由于不完全闭塞率和并发症发生率高，EVT仍然具有挑战性，并且它仅适用于血管构筑简单的超选择性AVF。恰当的治疗可带来良好的预后。

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