Tsukada Tetsuya, Izumi Takashi, Nishihori Masahiro, Araki Yoshio, Uda Kenji, Yokoyama Kinya, Saito Ryuta
Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Interv Neuroradiol. 2023 Aug 13:15910199231195135. doi: 10.1177/15910199231195135.
Dural arteriovenous fistulas (DAVFs) with cortical venous reflux (CVR) carry a high risk for neurological sequelae or death. Recently, transverse-sigmoid sinus DAVFs were shown as good indications for transarterial embolization (TAE) with ONYX. Here, we compared the effectiveness and safety of conventional transvenous embolization (TVE) with those of TAE with ONYX for transverse-sigmoid sinus DAVFs with CVR.
Sixty-one patients with transverse-sigmoid sinus DAVFs were treated from April 2013 to May 2020. Among them, 37 patients with CVR were included. Transarterial embolization and TVE were compared in terms of complete occlusion and residual CVR immediately after treatment, complications with worsening modified Rankin Scale (mRS) ≥ 1, amount of contrast media used during treatment, radiation exposure, and surgical procedure time.
Ten patients were treated with 10 TAEs using ONYX and 27 patients with 29 TVEs. Transarterial embolization and TVE showed no differences in the overall complete occlusion rate (80% [8/10 patients] vs. 80% [23/27], respectively), whereas the residual rate of existing CVR was 10% (1/10 patient) vs. 3.4% (1/27) in the TAE and TVE groups, respectively. No complications with worsening mRS ≥1 occurred in either group. Among the parameters of amount of contrast media, radiation dose, and operative time, only radiation dose in the TAE group was lower than that in the TVE group (median: 2239 mGy vs. 3268 mGy, respectively; = 0.07).
For transverse-sigmoid sinus DAVFs with CVR, TAE treatment reduced radiation exposure. However, both TAE and TVE achieved high complete occlusion rates and low complication rates.
伴有皮质静脉反流（CVR）的硬脑膜动静脉瘘（DAVF）具有较高的神经功能后遗症或死亡风险。最近，横窦-乙状窦DAVF被证明是使用ONYX进行经动脉栓塞（TAE）的良好适应证。在此，我们比较了传统经静脉栓塞（TVE）与使用ONYX进行TAE治疗伴有CVR的横窦-乙状窦DAVF的有效性和安全性。
2013年4月至2020年5月期间，对61例横窦-乙状窦DAVF患者进行了治疗。其中，纳入了37例伴有CVR的患者。比较了TAE和TVE在治疗后即刻的完全闭塞情况和残留CVR、改良Rankin量表（mRS）评分恶化≥1分的并发症、治疗期间使用的造影剂用量、辐射暴露以及手术操作时间。
10例患者接受了10次使用ONYX的TAE治疗，27例患者接受了29次TVE治疗。TAE和TVE的总体完全闭塞率无差异（分别为80%[8/10例患者]和80%[23/27例患者]），而TAE组和TVE组现有CVR的残留率分别为10%（1/10例患者）和3.4%（1/27例患者）。两组均未出现mRS评分恶化≥1分的并发症。在造影剂用量、辐射剂量和手术时间等参数中，仅TAE组的辐射剂量低于TVE组（中位数：分别为2239 mGy和3268 mGy；P = 0.07）。
对于伴有CVR的横窦-乙状窦DAVF，TAE治疗可减少辐射暴露。然而，TAE和TVE均实现了高完全闭塞率和低并发症率。
