Andrea Becerril-Gaitan, Pedram Peesh, Collin Liu, Cheng-Chia Lee, Huai-Che Yang, Ajay Niranjan, Lawrence Dade Lunsford, Zhishuo Wei, Andrew Hoang, Jason Sheehan, Samantha Dayawansa, Selçuk Peker, Yavuz Samanci, Robert M Starke, Ahmed Abdelsalam, Douglas Kondziolka, Kenneth Bernstein, Ying Ming, Go Ikeda, Hideyuki Kano, Manjul Tripathi, Roman Liscak, Jaromir May, Qian Wang, Wen Li, Babu Welch, Jennifer O'Con, Sepideh Amin-Hanjani, Quang Nguyen, Guiseppe Lanzino, Waleed Brinjikji, Minako Hayakawa, Edgar Samaniego, Rose Du, Rosalind Lai, Colin Derdeyn, Adib Abla, Bradley Gross, Felipe Albuquerque, Michael Lawton, Louis Kim, Michael Levitt, Ali Alaraj, Ethan Winkler, Nohra Chalouhi, Brian Hoh, Diederik Bulters, Andrew Durnford, Junichiro Satomi, Yoshiteru Tada, Mark van Dijk, Adriaan R E Potgieser, Dimitri Laurent, Josh Osbun, Brigette Bahmani, Gregory Zipfel, Ching-Jen Chen
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引用次数: 0
Abstract
Background: Given the low haemorrhagic risk of intracranial low-grade dural arteriovenous fistulas (dAVFs), the benefits of routine intervention remain controversial. This study compares patient outcomes treated with stereotactic radiosurgery (SRS) versus conservative management.
Method: Multicentre retrospective analysis of the Consortium for Dural Arteriovenous Fistula Outcomes Research and the International Radiosurgery Research Foundation data. Inclusion criteria were (1) intracranial low-grade dAVF diagnosed by catheter-based angiography, (2) no prior dAVF-related haemorrhage and (3) management with upfront SRS (intervention group) or conservative management (observation group). The primary outcome was symptomatic improvement. Secondary outcomes included dAVF obliteration, up-conversion, haemorrhage, improvement and favourable modified Rankin Scale (mRS) at follow-up.
Results: 304 patients with a mean age of 56 years (SD 13.5) and a follow-up of 46.7 months (SD 45.5) were included. 135 (44.4%) were managed conservatively and 169 (55.6%) had upfront SRS. Compared with the observation group, symptomatic and mRS Score improvement (≥1-point decrease in baseline score) was more likely in the intervention group (95.1% vs 58.5%; OR=13.75 (5.61-33.69) and 37.0% vs 24.0%; OR=1.85 (1.09-3.15), respectively). These findings remained significant after multiple imputation and propensity score matching. Remaining outcomes were similar between groups. The all-cause mortality rate was 5.4% (n=16), unrelated to the dAVF or treatment. Five (3.0%) SRS-related complications were reported and resolved during the follow-up period.
Conclusions: SRS was associated with increased symptomatic and mRS Score improvement for low-grade dAVFs compared with conservative management. SRS had a low complication risk and did not appear to alter dAVF obliteration or haemorrhage. Future prospective trials on SRS as a first-line intervention for symptomatic low-grade dAVFs should be considered.
背景：由于颅内低级别硬脑膜动静脉瘘（dAVFs）出血风险低，常规干预的益处仍然存在争议。本研究比较了立体定向放射手术（SRS）与保守治疗的患者预后。方法：多中心回顾性分析硬脑膜动静脉瘘结局研究联合会和国际放射外科研究基金会的数据。纳入标准为(1)经导管血管造影诊断为颅内低级别dAVF；(2)既往无dAVF相关出血；(3)接受前期SRS治疗（干预组）或保守治疗（观察组）。主要结局是症状改善。次要结果包括dAVF消除、上转换、出血、改善和随访时良好的改良Rankin量表（mRS）。结果：304例患者，平均年龄56岁（SD 13.5），随访46.7个月（SD 45.5）。保守治疗135例（44.4%），前期SRS治疗169例（55.6%）。与观察组相比，干预组更有可能出现症状和mRS评分改善（基线评分下降≥1分）(95.1% vs 58.5%；OR=13.75（5.61-33.69）和37.0% vs 24.0%；OR=1.85（分别为1.09-3.15）。这些发现在多次imputation和倾向评分匹配后仍然是显著的。各组之间的剩余结果相似。全因死亡率为5.4% (n=16)，与dAVF或治疗无关。5例（3.0%）srs相关并发症在随访期间得到解决。结论：与保守治疗相比，SRS与低级别davf的症状增加和mRS评分改善有关。SRS并发症风险低，似乎没有改变dAVF闭塞或出血。应考虑将SRS作为有症状的低级别davf的一线干预措施的未来前瞻性试验。
期刊介绍：
The Journal of Neurology, Neurosurgery & Psychiatry (JNNP) aspires to publish groundbreaking and cutting-edge research worldwide. Covering the entire spectrum of neurological sciences, the journal focuses on common disorders like stroke, multiple sclerosis, Parkinson’s disease, epilepsy, peripheral neuropathy, subarachnoid haemorrhage, and neuropsychiatry, while also addressing complex challenges such as ALS. With early online publication, regular podcasts, and an extensive archive collection boasting the longest half-life in clinical neuroscience journals, JNNP aims to be a trailblazer in the field.
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