Sulaiman Injam Ibrahim, Hassan Baker Ali, Shafeeq Azhin, Bani Saad Mohammed, Ismail Mustafa
Department of Surgery, Hawler Medical University, College of Medicine, Erbil, IRQ.
Department of Neurosurgery, Hawler Teaching Hospital, Erbil, IRQ.
Cureus. 2024 Nov 14;16(11):e73701. doi: 10.7759/cureus.73701. eCollection 2024 Nov.
The petrous and tentorial dural arteriovenous fistulas are vascular malformations that are very infrequent but highly aggressive, with a significant risk of intracranial hemorrhage and neurological deficits. Optimal management remains one of the most debated subjects, with various series reporting endovascular and microsurgical approaches. Therefore, this systematic review aims to assess the efficacy, safety, and outcomes of different treatment modalities of petrous and tentorial dural arteriovenous fistulas (DAVFs) based on clinical presentation, imaging techniques, treatment outcome, and complications arising in the course of their treatment. A systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was carried out, which aimed to identify literature regarding both petrous and tentorial DAVFs. Major databases, including PubMed and Scopus, are searched using various related terms. Patient demographics as well as clinical presentations of patients with petrous and tentorial DAVFs were abstracted concerning imaging modalities, approaches adopted for their treatment, and the eventual outcome. The quality of studies was assessed using the Newcastle-Ottawa Scale, and data were synthesized through descriptive analysis. A total of 14 studies involving 198 patients were included. The mean patient age ranged from 38 to 59.8 years, with a male predominance (78%). Clinical presentations varied from headaches and tinnitus to life-threatening intracranial hemorrhage. Digital subtraction angiography (DSA) was the gold standard for diagnosis, while MRI and CT were useful adjuncts in assessing hemorrhage and venous drainage. Endovascular embolization using Onyx achieved complete obliteration in the majority of cases, though recurrence was noted in fistulas with complex arterial supply. Microsurgical approaches, particularly in cases where endovascular treatment was insufficient, demonstrated high cure rates with low recurrence. Complications included cranial nerve palsies and, in rare cases, arterial or venous rupture. Mortality was low, with a case fatality rate of 0%-15.4% across the studies. Both endovascular and microsurgical treatments are effective for managing petrous and tentorial DAVFs, though microsurgery provides superior results in complex or recurrent cases. A combination of embolization and surgery offers the best chance for durable fistula obliteration. Early diagnosis and individualized treatment plans guided by advanced imaging are critical for optimizing patient outcomes.
岩骨和小脑幕硬脑膜动静脉瘘是非常罕见但极具侵袭性的血管畸形，有发生颅内出血和神经功能缺损的重大风险。最佳治疗方案仍是最具争议的话题之一，不同系列报道了血管内治疗和显微外科治疗方法。因此，本系统评价旨在基于临床表现、成像技术、治疗结果以及治疗过程中出现的并发症，评估岩骨和小脑幕硬脑膜动静脉瘘（DAVF）不同治疗方式的疗效、安全性和结局。基于系统评价和Meta分析的首选报告项目（PRISMA）进行了一项系统评价，旨在识别有关岩骨和小脑幕DAVF的文献。使用各种相关术语搜索包括PubMed和Scopus在内的主要数据库。提取了岩骨和小脑幕DAVF患者的人口统计学数据以及临床表现，涉及成像方式、所采用的治疗方法以及最终结局。使用纽卡斯尔-渥太华量表评估研究质量，并通过描述性分析对数据进行综合。共纳入14项研究，涉及198例患者。患者平均年龄在38至59.8岁之间，男性占主导（78%）。临床表现从头痛、耳鸣到危及生命的颅内出血不等。数字减影血管造影（DSA）是诊断的金标准，而MRI和CT在评估出血和静脉引流方面是有用的辅助手段。使用Onyx进行血管内栓塞在大多数病例中实现了完全闭塞，尽管在动脉供应复杂的瘘中观察到复发。显微外科治疗方法，特别是在血管内治疗不足的情况下，显示出高治愈率和低复发率。并发症包括脑神经麻痹，在罕见情况下，还包括动脉或静脉破裂。死亡率较低，各研究的病死率为0%-15.4%。血管内治疗和显微外科治疗对治疗岩骨和小脑幕DAVF均有效，不过在复杂或复发病例中，显微外科手术效果更佳。栓塞和手术相结合为持久闭塞瘘提供了最佳机会。早期诊断和由先进成像引导的个体化治疗方案对于优化患者结局至关重要。
