Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
China International Neuroscience Institute (China-INI), Beijing, China.
Neurosurgery. 2024 Sep 1;95(3):692-701. doi: 10.1227/neu.0000000000002939. Epub 2024 Apr 15.
Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are rare. Variability in clinical manifestations and treatment strategies for CCJ AVFs stems from differences in their angioarchitecture. Our study aims to categorize CCJ AVFs based on their angioarchitecture and explore the associated clinical features and treatment modalities for distinct CCJ AVF types.
The authors conducted a retrospective analysis of patients with CCJ AVFs treated at a single neurosurgical facility over the past decade. These patients were classified based on the angioarchitecture of their CCJ AVFs. The analysis included an evaluation of angioarchitecture, clinical characteristics, treatment strategies, and outcomes.
The study included 155 patients, with a median age of 56 years, collectively manifesting 165 CCJ AVFs. Our classification identified 4 distinct CCJ AVF types: epidural AVFs (19 [11.5%]), dural AVFs (98 [59.4%]), radicular AVFs (33 [20.0%]), and perimedullary AVFs (15 [9.1%]). Further differentiation was applied based on the presence of pial feeders. The predominant fistula location was at cervical-1 (77.0%). Ascending intradural drainage (52.7%) and descending intradural drainage (52.1%) were frequently observed drainage patterns. Patients with dural AVF predominantly presented with venous hypertensive myelopathy, whereas patients with other types of CCJ AVFs showed a higher incidence of subarachnoid hemorrhage (P = .012). Microsurgery was the predominant treatment, applied in the management of 126 (76.4%) AVFs, whereas 8 (4.8%) AVFs exclusively underwent interventional embolization and 25 (15.2%) received a combination of interventional embolization and microsurgical treatment.
CCJ AVFs can be distinguished based on the fistula location and the arterial feeders. Currently, microsurgery stands as the preferred treatment strategy for CCJ AVFs, whereas interventional embolization plays a distinctive role in cases with specific angioarchitecture or as a pretreatment measure before microsurgery.
颅颈交界区（CCJ）动静脉瘘（AVF）较为罕见。CCJ AVF 的临床表现和治疗策略存在差异，这主要归因于其血管结构的多样性。本研究旨在根据 CCJ AVF 的血管结构对其进行分类，并探讨不同 CCJ AVF 类型的相关临床特征和治疗方式。
作者对过去十年间在单一神经外科中心接受治疗的 CCJ AVF 患者进行了回顾性分析。根据 CCJ AVF 的血管结构对这些患者进行分类。分析内容包括血管结构、临床特征、治疗策略和结局。
本研究共纳入 155 例患者，中位年龄为 56 岁，共表现出 165 例 CCJ AVF。我们的分类确定了 4 种不同的 CCJ AVF 类型：硬膜外 AVF（19 例，11.5%）、硬膜内 AVF（98 例，59.4%）、神经根 AVF（33 例，20.0%）和脊髓旁 AVF（15 例，9.1%）。进一步根据有无软膜供血进行了细分。主要瘘口位置位于 C1（77.0%）。颅内硬膜上行引流（52.7%）和颅内硬膜下行引流（52.1%）是常见的引流模式。硬膜内 AVF 患者主要表现为静脉高压性脊髓病，而其他类型的 CCJ AVF 患者蛛网膜下腔出血的发生率更高（P =.012）。微血管手术是主要的治疗方法，应用于 126 例（76.4%）AVF 的治疗，而 8 例（4.8%）AVF 仅接受介入栓塞治疗，25 例（15.2%）接受介入栓塞和微血管手术联合治疗。
可以根据瘘口位置和动脉供血来区分 CCJ AVF。目前，微血管手术是 CCJ AVF 的首选治疗策略，而介入栓塞在具有特定血管结构或作为微血管手术前预处理措施的情况下具有独特的作用。
