Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing , China.
Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing , China.
Neurosurgery. 2024 Apr 1;94(4):771-779. doi: 10.1227/neu.0000000000002748. Epub 2023 Nov 6.
Recent studies suggest a bidirectional relationship of dural arteriovenous fistula (DAVF) with cerebral venous thrombosis (CVT). We aimed to compare the characteristics of patients with DAVF with or without CVT and to analyze the risk factors for the coexistence of CVT in a DAVF population.
A total of 511 adult patients with DAVF were enrolled consecutively in our hospital from February 2019 through November 2022. Demographic data, clinical manifestations, and imaging characteristics were reviewed in detail. The patients with DAVF were divided into two groups: DAVF with CVT (DAVF-CVT) group and without CVT (DAVF alone) group. Univariate logistic regression and multivariate logistic regression were used to analyze the risk factors for the coexistence of CVT and DAVF.
CVT was found in 19.8% of patients with DAVF. In univariate analysis, compared with the DAVF-alone group, the DAVF-CVT group was more likely to have tinnitus ( P = .001), blurred vision ( P < .001), visual field loss ( P = .001), focal neurological deficits ( P = .002), seizures ( P = .008), and cognitive impairment ( P = .046) and less likely to have spinal cord/brain stem dysfunction ( P = .004). In addition, there were significant differences in age ( P = .009), sex ( P = .019), the occurrence of venous cerebral infarction ( P = .001), and DAVF location ( P < .001) between the two groups. Furthermore, multivariate analysis showed that blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF were risk factors for the coexistence of CVT in patients with DAVF, with the odds ratio of 2.416 (95% CI 1.267-4.606, P = .007), 6.018 (95% CI 1.289-28.100, P = .022), 5.801 (95% CI 2.494-13.496, P < .001), and 5.640 (95% CI 2.122-14.989, P = .001), respectively.
CVT occurred in approximately one fifth of patients with DAVF. Blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF may be the risk factors for predicting the coexistence of CVT in patients with DAVF.
近期研究表明，硬脑膜动静脉瘘（DAVF）与脑静脉血栓形成（CVT）之间存在双向关系。我们旨在比较伴有或不伴有 CVT 的 DAVF 患者的特征，并分析 DAVF 人群中 CVT 共存的危险因素。
本研究连续纳入了 2019 年 2 月至 2022 年 11 月期间在我院就诊的 511 例成年 DAVF 患者。详细回顾了患者的人口统计学数据、临床表现和影像学特征。将 DAVF 患者分为两组：伴有 CVT 的 DAVF（DAVF-CVT）组和不伴有 CVT 的 DAVF（单纯 DAVF）组。采用单因素逻辑回归和多因素逻辑回归分析 CVT 共存与 DAVF 的危险因素。
19.8%的 DAVF 患者存在 CVT。在单因素分析中，与单纯 DAVF 组相比，DAVF-CVT 组更易出现耳鸣（P=.001）、视力模糊（P<.001）、视野缺损（P=.001）、局灶性神经功能缺损（P=.002）、癫痫发作（P=.008）和认知障碍（P=.046），而更不易出现脊髓/脑干功能障碍（P=.004）。此外，两组间的年龄（P=.009）、性别（P=.019）、静脉性脑梗死的发生（P=.001）和 DAVF 位置（P<.001）也存在显著差异。此外，多因素分析显示，视力模糊、静脉性脑梗死、大窦 DAVF 和多发 DAVF 是 DAVF 患者 CVT 共存的危险因素，其比值比（OR）分别为 2.416（95%CI 1.267-4.606，P=.007）、6.018（95%CI 1.289-28.100，P=.022）、5.801（95%CI 2.494-13.496，P<.001）和 5.640（95%CI 2.122-14.989，P=.001）。
大约五分之一的 DAVF 患者存在 CVT。视力模糊、静脉性脑梗死、大窦 DAVF 和多发 DAVF 可能是预测 DAVF 患者 CVT 共存的危险因素。
