Endovascular Treatment With Targeted Embolization of Cavernous Sinus Dural Arteriovenous Fistulas: A Single-Center Study.

IF 4.4 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Korean Journal of Radiology Pub Date : 2024-11-08 DOI:10.3348/kjr.2024.0351

Sangil Park, Kyubong Lee, Eunji Moon, Jung Cheol Park, Boseong Kwon, Deok Hee Lee, Dae Chul Suh, Yunsun Song

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引用次数: 0

Abstract

Objective: To assess the feasibility, efficacy, and safety of targeted embolization for cavernous sinus dural arteriovenous fistulas (CSDAVF).

Materials and methods: This retrospective study investigated patients with CSDAVF who underwent endovascular treatment at a tertiary hospital between October 1991 and March 2023. Treatment strategies were determined based on clinical symptoms and shunt characteristics. Targeted or non-targeted curative embolization was performed to achieve complete shunt occlusion. Initially, targeted embolization, selective occlusion of the shunted pouch while preserving the normal cavernous sinus lumen, was conducted, should that fail, non-targeted embolization was performed. In contrast, palliative embolization solely reduced shunt flow. Clinical signs, imaging characteristics, and outcomes were evaluated according to the agreed treatment strategy.

Results: In total, 198 patients with CSDAVF (mean age 59.0 ± 12.1 years, 23.2% male) participated in this study. Of which, 94 patients (47.5%) were treated with targeted embolization, 75 (37.9%) with non-targeted embolization, and 29 (14.6%) with palliative treatment. For patients undergoing curative embolization, 55.7% (94/169) successfully achieved targeted embolization; this procedure was usually used to treat focal fistulas (restrictive or late-restrictive types), whereas diffuse fistulas (proliferative type) often underwent non-targeted or palliative embolization. For patients that underwent targeted embolization, the rate of complete or near-complete occlusion on immediate post-treatment digital subtraction angiography was 93.6% (88/94), with a complication rate of 2.1% (2/94), symptom improvement rate of 96.8% (91/94), and retreatment rate of 5.3% (5/94). No serious complications were reported during follow-up.

Conclusion: When successful, targeted embolization of CSDAVF causes low rates of cranial nerve palsy, retreatment, and good clinical outcomes.

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海绵窦硬脑膜动静脉瘘的血管内靶向栓塞治疗：一项单中心研究

摘要评估靶向栓塞治疗海绵窦硬脑膜动静脉瘘（CSDAVF）的可行性、有效性和安全性：这项回顾性研究调查了 1991 年 10 月至 2023 年 3 月期间在一家三级医院接受血管内治疗的 CSDAVF 患者。根据临床症状和分流特征确定治疗策略。通过靶向或非靶向治疗性栓塞实现分流完全闭塞。首先，进行靶向栓塞，在保留正常海绵窦腔的同时选择性地闭塞分流袋；如果失败，则进行非靶向栓塞。相比之下，姑息性栓塞仅能减少分流流量。根据商定的治疗策略对临床症状、影像学特征和疗效进行评估：共有 198 名 CSDAVF 患者（平均年龄为 59.0 ± 12.1 岁，23.2% 为男性）参与了此次研究。其中，94 名患者（47.5%）接受了靶向栓塞治疗，75 名患者（37.9%）接受了非靶向栓塞治疗，29 名患者（14.6%）接受了姑息治疗。在接受根治性栓塞治疗的患者中，55.7%（94/169）的患者成功接受了靶向栓塞治疗；这种治疗方法通常用于治疗局灶性瘘管（局限性或晚期局限性类型），而弥漫性瘘管（增殖性类型）通常接受非靶向或姑息性栓塞治疗。对于接受靶向栓塞治疗的患者，治疗后立即进行数字减影血管造影的完全或接近完全闭塞率为93.6%（88/94），并发症发生率为2.1%（2/94），症状改善率为96.8%（91/94），再治疗率为5.3%（5/94）。随访期间未发现严重并发症：结论：CSDAVF 靶向栓塞术成功后，颅神经麻痹发生率低，再治疗率高，临床疗效好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Korean Journal of Radiology 医学-核医学

CiteScore

10.60

自引率

12.50%

发文量

141

审稿时长

1.3 months

期刊介绍： The inaugural issue of the Korean J Radiol came out in March 2000. Our journal aims to produce and propagate knowledge on radiologic imaging and related sciences. A unique feature of the articles published in the Journal will be their reflection of global trends in radiology combined with an East-Asian perspective. Geographic differences in disease prevalence will be reflected in the contents of papers, and this will serve to enrich our body of knowledge. World''s outstanding radiologists from many countries are serving as editorial board of our journal.