Schimmel Samantha, Dunn Emma, Sargent Emma, Goldman Daryl T, Pressman Elliot, Guerrero Waldo, Mokin Maxim, Agazzi Siviero, Vakharia Kunal
Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA.
Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.
Clin Neurol Neurosurg. 2025 Feb;249:108734. doi: 10.1016/j.clineuro.2025.108734. Epub 2025 Jan 8.
Dural arteriovenous fistulas (dAVF) are abnormal anastomoses between meningeal arteries and dural venous sinuses. Typically, dAVF treatment involves an endovascular or microsurgical approach. Anterior ethmoidal artery (AEA) dAVFs pose unique challenges due to their anatomy and location. We performed a scoping review to characterize pre and postoperative characteristics of AEA dAVFs and elucidate their optimal management.
The authors conducted a comprehensive literature search on PubMed and Embase using Arskey & O'Malley's scoping review framework. The search strategy included "anterior," "ethmoidal," and "fistula" and excluded review articles and studies with unrelated pathology. Data collected included patient demographics, presentation, angiographic features, treatment modalities, and clinical and radiological outcomes.
One-hundred and two articles describing 273 patients with an average age of 58.79 years were included. Two-hundred and sixty patients had surgery; 127 (49 %) had endovascular embolization and 133 (51 %) had open surgery. Surgical approach was significantly associated with complete dAVF obliteration (p = 0.003, X=8.73, N = 206); patients treated endovascularly were less likely to have complete dAVF obliteration (85.9 % for endovascular versus 97.2 % for microsurgery). Additionally, patients with preoperative dAVF rupture had significantly greater rates of postoperative hemorrhage (p = 0.003, X=11.86, N = 184).
Surgical techniques and endovascular embolization are commonly used when treating dAVF, and our results highlight that open surgery appears to be superior to endovascular embolization when considering complete AEA dAVF obliteration. Despite advancements in treatment modalities, complications such as stroke, hemorrhage, and recurrence persist, emphasizing the importance of continued research and refinement of therapeutic strategies.
硬脑膜动静脉瘘（dAVF）是脑膜动脉与硬脑膜静脉窦之间的异常吻合。通常，dAVF的治疗包括血管内或显微外科手术方法。筛前动脉（AEA）dAVF因其解剖结构和位置而带来独特的挑战。我们进行了一项范围综述，以描述AEA dAVF的术前和术后特征，并阐明其最佳治疗方法。
作者使用Arskey和O'Malley的范围综述框架在PubMed和Embase上进行了全面的文献检索。检索策略包括“筛前”、“筛骨的”和“瘘”，并排除综述文章和有无关病理学的研究。收集的数据包括患者人口统计学、临床表现、血管造影特征、治疗方式以及临床和放射学结果。
纳入了102篇描述273例平均年龄为58.79岁患者的文章。260例患者接受了手术；127例（49%）接受了血管内栓塞，133例（51%）接受了开放手术。手术方式与dAVF完全闭塞显著相关（p = 0.003，X = 8.73，N = 206）；接受血管内治疗的患者dAVF完全闭塞的可能性较小（血管内治疗为85.9%，显微手术为97.2%）。此外，术前dAVF破裂的患者术后出血率显著更高（p = 0.003，X = 11.86，N = 184）。
在治疗dAVF时，手术技术和血管内栓塞是常用的方法，我们的结果表明，在考虑AEA dAVF完全闭塞时，开放手术似乎优于血管内栓塞。尽管治疗方式有所进步，但中风、出血和复发等并发症仍然存在，这强调了持续研究和改进治疗策略的重要性。
