Zheng Jingwei, Su Shixing, Lu Hua, Liu Sheng, Zhou Shengjun, Jia Qi, Bao Xiang, Li Zhenqiang, Zhou Haihang, Zhang Guoqiang, Jiang Zhijie, Liu Fei, Hu Si, Wang Zixin, Yu Jun, Xu Liang
Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang, China.
J Neurointerv Surg. 2025 Jul 18. doi: 10.1136/jnis-2025-023381.
Cavernous sinus dural arteriovenous fistulas (CS-DAVFs) present significant treatment challenges when the inferior petrosal sinus (IPS) is not opacified during cerebral angiography. The consistently visible superior ophthalmic vein (SOV) offers a promising alternative, though it has yet to be fully evaluated in large-scale studies.
This retrospective, case-control study was conducted between May 2017 and October 2024. Data collection for this multicenter, population-based study took place across eight tertiary referral centers. Eligible patients diagnosed with CS-DAVF and non-visualized IPS were treated either via the transvenous SOV approach or the IPS recanalization approach.
Of 178 eligible cases, 70 cases (39.33%) were treated using the transvenous SOV approach, while 108 cases (60.67%) underwent the transvenous IPS approach. The initial treatment success rate was significantly higher in the SOV group compared with the IPS group (91.43% vs 75.93%; OR 3.38, 95% CI 1.30 to 8.35, P=0.01). The overall complication rate was 1.43% in the SOV group and 2.78% in the IPS group (OR 0.51, 95% CI 0.04 to 3.47, P>0.99). After classifying the SOV approach into simple and complex types, the SOV-simple type further demonstrated significant advantages, including shorter average operation times (126.20±46.99 min, P=0.02) and a higher initial treatment success rate (95.65%, P=0.003) compared with the IPS group.
The SOV approach is recommended as a first-line treatment for CS-DAVF patients with 'invisible' IPS.
当脑血管造影时岩下窦（IPS）未显影时，海绵窦硬脑膜动静脉瘘（CS-DAVF）的治疗面临重大挑战。始终可见的眼上静脉（SOV）提供了一种有前景的替代方法，尽管尚未在大规模研究中得到充分评估。
这项回顾性病例对照研究于2017年5月至2024年10月进行。这项基于人群的多中心研究的数据收集在八个三级转诊中心进行。符合条件的被诊断为CS-DAVF且IPS未显影的患者通过经静脉SOV方法或IPS再通方法进行治疗。
在178例符合条件的病例中，70例（39.33%）采用经静脉SOV方法治疗，而108例（60.67%）采用经静脉IPS方法。SOV组的初始治疗成功率显著高于IPS组（91.43%对75.93%；OR 3.38，95%CI 1.30至8.35，P=0.01）。SOV组的总体并发症发生率为1.43%，IPS组为2.78%（OR 0.51，95%CI 0.04至3.47，P>0.99）。将SOV方法分为简单型和复杂型后，SOV简单型进一步显示出显著优势，包括与IPS组相比平均手术时间更短（126.20±46.99分钟，P=0.02）和初始治疗成功率更高（95.65%，P=0.003）。
对于IPS“不可见”的CS-DAVF患者，推荐SOV方法作为一线治疗。
