颅颈交界处硬脑膜动静脉瘘：系统评价和荟萃分析。
Dural arteriovenous fistulas at the craniocervical junction: a systematic review and meta-analysis.
机构信息
College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia.
出版信息
Neurosurg Rev. 2024 Oct 23;47(1):812. doi: 10.1007/s10143-024-03018-3.
BACKGROUND
The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management.
METHODS
Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes.
RESULTS
We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2-64.5), 58.8 years (95%CI: 48.4-69.2), and 63.8 years (95%CI: 60.1-67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3-88.2%) in the microsurgery group and 54.9% (95%CI:30.7-77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7-34.5%) in the embolization group, 11.6% (95%CI:3.8-30.4%) in the microsurgery group, and 7.7% (95%CI:1.1-39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1-80.8%), embolization: 51.9% (95%CI:30.8-72.4%), and conservative: 11.6% (95%CI:4.4-27.4%)].
CONCLUSIONS
In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics.
背景
颅颈交界区硬脑膜动静脉瘘（CCJ-DAVFs）的治疗仍然存在争议，极具临床挑战性。我们系统地总结了显微手术、栓塞和保守治疗的临床和血管造影结果。
方法
根据 PRISMA 指南，从 PubMed、Scopus、Web of Science 和 Cochrane 中检索相关文章。对临床特征、治疗方法以及临床和血管造影结果进行了系统回顾和荟萃分析。
结果
我们纳入了 13 篇文章（166 例患者）。在显微手术、栓塞和保守治疗组中，加权平均年龄分别为 58.9 岁（95%CI：53.2-64.5）、58.8 岁（95%CI：48.4-69.2）和 63.8 岁（95%CI：60.1-67.5），总体上男性居多（显微手术组[n=51/77，66.2%]，栓塞组[n=44/56，78.6%]和保守治疗组[n=6/8，75.0%]）。患者接受了显微手术（n=80/172，46.5%）、栓塞（n=79/172，45.9%）和保守治疗（n=13/172，7.6%）。其中，颅颈交界区是最常见的瘘口位置（显微手术组[n=34/77，44.2%]，栓塞组[n=31/56，55.4%]和保守治疗组[n=3/8，37.5%]）。椎动脉是主要供血动脉（显微手术组[n=58/84，69.1%]，栓塞组[n=41/86，47.6%]和保守治疗组[n=4/7，57.1%]）。显微手术组完全瘘口闭塞率为 74.1%（95%CI：52.3-88.2%），栓塞组为 54.9%（95%CI：30.7-77.0%）。栓塞组并发症发生率为 16.2%（95%CI：6.7-34.5%），显微手术组为 11.6%（95%CI：3.8-30.4%），保守治疗组为 7.7%（95%CI：1.1-39.1%）。不同治疗组的临床预后良好率也不同[显微手术组：66.4%（95%CI：48.1-80.8%），栓塞组：51.9%（95%CI：30.8-72.4%），保守治疗组：11.6%（95%CI：4.4-27.4%）]。
结论
对于颅颈交界区硬脑膜动静脉瘘患者，根据瘘口和患者特征，每种治疗方法都有其优点。
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