Multiple synchronous intracranial dural arteriovenous fistulas.

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Xin Su, Zihao Song, Yongjie Ma, Hongqi Zhang, Peng Zhang
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引用次数: 0

Abstract

Background: Intracranial multiple dural arteriovenous fistulas (DAVFs) are rare, with most reports limited to small case series and basic descriptive analyses. To better understand this condition-often linked to lower cure rates and higher progression risk-we conducted a comparative analysis of their angiographic characteristics, clinical presentations, and outcomes.

Methods: Data were retrospectively collected from the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database. Lesions were classified as multifocal or diffuse based on angiographic features, and as progressive or non-progressive based on follow-up angiographic findings. We compared these subtypes as well as multiple versus single DAVFs, and further investigated the predictors of disease progression in patients with multiple DAVFs.

Results: A total of 90 cases of multiple synchronous DAVFs were included. Compared to the multifocal type, diffuse-type patients were younger (P = 0.002), and more frequently exhibited sinus occlusion/stenosis (P = 0.019), sinus-type DAVF (P < 0.001), pial artery supply (P = 0.009), venous congestion (P = 0.030), and lower complete obliteration rates (P = 0.001). Progressive DAVFs were associated with younger age (P = 0.001), sinus-type DAVF (P = 0.020), higher rates of diffuse-type lesions (P < 0.001), pial artery supply (P = 0.037), deep venous drainage (P = 0.032), and venous congestion (P = 0.005). Among the 14 treatment-related complications, 8 (57.1%) were associated with pial artery embolization. Compared to single DAVFs, patients with multiple DAVFs had a significantly lower rate of good outcomes (P < 0.001) and a higher incidence of fistula-related death (P = 0.001). On multivariate analysis, only younger age remained a significant predictor of progression (OR 2.86; 95% CI 1.02-7.99; P = 0.045).

Conclusions: Diffuse and progressive types often occur in younger patients and are associated with sinus-type fistulas and venous hypertension-related angioarchitectural features. Disease progression may involve enhanced neoangiogenesis. Treatment of refractory DAVFs should prioritize reducing venous hypertension and improving cerebral hemodynamics, rather than solely pursuing complete obliteration.

多发性颅内同步硬脑膜动静脉瘘。
背景:颅内多发性硬脑膜动静脉瘘(davf)是罕见的,大多数报道仅限于小病例系列和基本的描述性分析。为了更好地了解这种通常与较低治愈率和较高进展风险相关的疾病,我们对他们的血管造影特征、临床表现和结果进行了比较分析。方法:回顾性收集中国硬脑膜动静脉瘘研究与管理数据库(DREAM-INI)的数据。病变根据血管造影特征分为多灶性或弥漫性,根据随访血管造影结果分为进展性或非进展性。我们比较了这些亚型以及多个davf和单个davf,并进一步研究了多个davf患者疾病进展的预测因素。结果:共纳入90例多发性同步davf。与多灶型相比,弥漫性和进行性DAVF患者更年轻(P = 0.002),更常表现为窦闭塞/狭窄(P = 0.019),窦型DAVF (P)结论:弥漫性和进行性DAVF常发生在年轻患者中,并伴有窦型瘘和静脉高压相关的血管结构特征。疾病进展可能涉及新血管生成增强。难治性davf的治疗应优先考虑降低静脉高压和改善脑血流动力学,而不是仅仅追求完全闭塞。
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来源期刊
Neurosurgical Review
Neurosurgical Review 医学-临床神经学
CiteScore
5.60
自引率
7.10%
发文量
191
审稿时长
6-12 weeks
期刊介绍: The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.
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