Iampreechakul Prasert, Wangtanaphat Korrapakc, Chuntaroj Songpol, Angsusing Chonlada, Wattanasen Yodkhwan, Hangsapruek Sunisa, Lertbutsayanukul Punjama, Siriwimonmas Somkiet
Department of Neurosurgery, Neurological Institute of Thailand, Bangkok, Thailand.
Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand.
Asian J Neurosurg. 2025 May 5;20(3):462-477. doi: 10.1055/s-0045-1809046. eCollection 2025 Sep.
Lower cervical arteriovenous fistulas (AVFs) are rare and complex vascular malformations that pose significant clinical challenges due to their location and variable presentation. While upper cervical AVFs have been extensively studied, lower cervical AVFs remain underresearched. This study aims to review the clinical presentations, management strategies, and outcomes of patients with lower cervical AVFs to enhance understanding and improve treatment approaches. We conducted a retrospective analysis of patients with spinal vascular malformations treated at our institute between June 2006 and December 2023, identifying two cases of lower cervical AVFs. Additionally, a systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including 44 patients with lower cervical AVFs, using databases such as Ovid MEDLINE, PubMed, and Cochrane. Data collected included patient demographics, clinical presentation, fistula type, arterial and venous involvement, treatment modality, and neurological outcomes. Among the 44 patients with lower cervical AVFs, including our two cases, 50% were female, and the mean age was 48.68 years (range: 4-76 years). Clinical presentations varied, with 27.3% experiencing hemorrhage, 18.2% presenting with myelopathy, and 18.2% remaining asymptomatic. Venous drainage patterns played a significant role in symptom severity, with complex perimedullary and retrograde venous drainage contributing to worse outcomes. Treatment included endovascular embolization (40.9%), surgical resection (25%), and combined approaches (18.2%), with good recovery achieved in 54.5% of cases. Lower cervical AVFs present diverse clinical challenges due to their variable presentations and complex vascular anatomy. Early diagnosis and tailored management, including endovascular embolization and surgical resection, are essential for optimizing patient outcomes. Further research is needed to better understand the natural history of asymptomatic AVFs and improve treatment protocols.
下颈椎动静脉瘘（AVF）是罕见且复杂的血管畸形，因其位置和表现多样而带来重大临床挑战。虽然上颈椎AVF已得到广泛研究，但下颈椎AVF仍研究不足。本研究旨在回顾下颈椎AVF患者的临床表现、管理策略和治疗结果，以增进了解并改进治疗方法。我们对2006年6月至2023年12月在我院接受治疗的脊髓血管畸形患者进行了回顾性分析，确定了2例下颈椎AVF患者。此外，按照系统评价和Meta分析的首选报告项目指南进行了系统文献回顾，使用Ovid MEDLINE、PubMed和Cochrane等数据库，纳入了44例下颈椎AVF患者。收集的数据包括患者人口统计学资料、临床表现、瘘管类型、动静脉受累情况、治疗方式和神经学结果。在包括我们这2例患者在内的44例下颈椎AVF患者中，50%为女性，平均年龄为48.68岁（范围：4至76岁）。临床表现各不相同，27.3%的患者发生出血，18.2%的患者表现为脊髓病，18.2%的患者无症状。静脉引流模式在症状严重程度方面起重要作用，复杂的髓周和逆行静脉引流导致更差的结果。治疗方法包括血管内栓塞（40.9%）、手术切除（25%）和联合治疗（18.2%），54.5%的病例恢复良好。下颈椎AVF因其表现多样和血管解剖结构复杂而带来各种临床挑战。早期诊断和针对性管理，包括血管内栓塞和手术切除，对于优化患者治疗结果至关重要。需要进一步研究以更好地了解无症状AVF的自然病程并改进治疗方案。
