Xu Liang, Jiang Zhijie, Hu Si, Zheng Jingwei, Zhang Guoqiang, Ling Chenhan, Chen Xianyi, Fang Bing, Qian Cong, Xu Jing, Yu Jun
1Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang.
2Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang.
J Neurosurg. 2025 Apr 4;143(2):505-511. doi: 10.3171/2024.12.JNS241501. Print 2025 Aug 1.
Cribriform plate dural arteriovenous fistula (DAVF) is a rare lesion associated with a high risk of bleeding. Transarterial embolization (TAE) has been widely recognized as the first-line treatment. However, limited data exist regarding the safety and efficacy of transvenous embolization (TVE). The aim of this study was to report on a cohort of patients with cribriform plate DAVFs who underwent endovascular treatment (EVT), detailing both clinical and angiographic outcomes.
This single-center case series was conducted from January 2016 to June 2024, including 26 cases in which cribriform plate DAVFs were treated with EVT. A retrospective review of clinical and radiological data was performed. The safety and efficacy of TAE and TVE were compared and further analyzed by including results from the literature published over the past decade.
A total of 25 patients (mean age 60.2 ± 8.3 years; all male) in 26 cases were included in this study. The immediate postoperative total embolization rates were 53.8% (7/13) and 100% (13/13) for TAE and TVE, respectively, resulting in an overall success rate of 76.9% (20/26). TVE demonstrated a significantly higher success rate than that of TAE (p = 0.015). Three TAE cases had surgical complications, including microcatheter fracture (2/3) and thromboembolism (1/3). The TVE group experienced no symptomatic complications. Similar results were observed in the literature review.
TVE might be considered as a preferential strategy for cribriform plate DAVFs in select cases. For optimal safety, it is crucial to navigate microcatheters into the cortical vein using the wire-loop technique. Further studies are required to validate its safety and efficacy.
筛板硬脑膜动静脉瘘（DAVF）是一种罕见的病变，出血风险高。经动脉栓塞术（TAE）已被广泛认可为一线治疗方法。然而，关于经静脉栓塞术（TVE）的安全性和有效性的数据有限。本研究的目的是报告一组接受血管内治疗（EVT）的筛板DAVF患者，详细说明临床和血管造影结果。
本单中心病例系列研究于2016年1月至2024年6月进行，包括26例采用EVT治疗筛板DAVF的病例。对临床和放射学数据进行回顾性分析。比较TAE和TVE的安全性和有效性，并通过纳入过去十年发表的文献结果进行进一步分析。
本研究纳入了26例中的25例患者（平均年龄60.2±8.3岁；均为男性）。TAE和TVE术后即刻完全栓塞率分别为53.8%（7/13）和100%（13/13），总体成功率为76.9%（20/26）。TVE的成功率显著高于TAE（p = 0.015）。3例TAE病例出现手术并发症，包括微导管断裂（2/3）和血栓栓塞（1/3）。TVE组未出现有症状的并发症。文献综述也观察到类似结果。
在某些情况下，TVE可被视为筛板DAVF的优先治疗策略。为确保最佳安全性，使用线环技术将微导管导航至皮质静脉至关重要。需要进一步研究以验证其安全性和有效性。
