Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China.
Department of Neurosurgery, Urumqi Friendship Hospital, Urumqi, China.
World Neurosurg. 2024 Sep;189:e310-e323. doi: 10.1016/j.wneu.2024.06.042. Epub 2024 Jun 13.
Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are commonly treated by transvenous embolization, but the details of treatment need to be more clearly defined. We propose a classification of CS-DAVF that can contribute to formulating endovascular treatment process.
CS-DAVF was classified into seven categories based on the cumulative CS range and drainage patterns. CS-DAVF angioarchitecture, clinical characteristics, treatment strategies, and outcomes of CS-DAVF patients treated in our hospital from 2012 to 2021 were summarized and analyzed.
Among the 116 patients with CS-DAVF: Type 1, 71 (61.2%); Type 2, 9 (7.8%); Type 3, 18 (15.5%); Type 4, 2 (1.7%); Type 5, 8 (6.9%); Type 6, 3 (2.6%); and Type 7, 5 (4.3%). Inter-CS or inferior petrosal sinus drainage was relatively rare in Types 1 and 6 (P < 0.001 and P < 0.001); basilar venous plexus drainage was more prevalent in Types 2, 5, and 7(P = 0.019). Inferior petrosal sinus occlusion was more commonly seen in Types 2, 3, and 5 (P = 0.005). The most frequent first symptoms and symptoms at admission in patients with CS-DAVF is ocular/orbital symptoms, occurring in 64 cases (55.2%) and 104 cases (89.7%), respectively. In this study, 108 patients (93.1%) underwent endovascular embolization. Among those who received endovascular embolization, 96 (88.9%) CS-DAVFs were treated via transvenous embolization. In long-term follow-up, 98 cases (84.5%) achieved cure, and 17 cases (14.7%) showed symptomatic improvement.
Our proposed classification system based on cumulative CS range and drainage patterns can assist in formulating treatment strategies for transvenous embolization.
海绵窦（CS）硬脑膜动静脉瘘（DAVF）通常采用经静脉栓塞治疗，但需要更明确地定义治疗细节。我们提出了一种 CS-DAVF 分类方法，有助于制定血管内治疗方案。
根据 CS 累积范围和引流模式，将 CS-DAVF 分为七类。总结和分析了 2012 年至 2021 年在我院治疗的 CS-DAVF 患者的 CS-DAVF 血管造影结构、临床特征、治疗策略和结果。
在 116 例 CS-DAVF 患者中：1 型 71 例（61.2%）；2 型 9 例（7.8%）；3 型 18 例（15.5%）；4 型 2 例（1.7%）；5 型 8 例（6.9%）；6 型 3 例（2.6%）；7 型 5 例（4.3%）。1 型和 6 型 CS 或岩下窦引流相对较少（P<0.001 和 P<0.001）；2 型、5 型和 7 型基底静脉丛引流更常见（P=0.019）。2 型、3 型和 5 型更常见闭塞岩下窦（P=0.005）。CS-DAVF 患者最常见的首发症状和入院时的症状是眼部/眼眶症状，分别发生在 64 例（55.2%）和 104 例（89.7%）。本研究中，108 例（93.1%）患者接受了血管内栓塞治疗。在接受血管内栓塞治疗的患者中，96 例（88.9%）CS-DAVF 通过经静脉栓塞治疗。在长期随访中，98 例（84.5%）患者达到治愈，17 例（14.7%）患者症状改善。
我们提出的基于 CS 累积范围和引流模式的分类系统有助于制定经静脉栓塞治疗的策略。
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