Navigating the epidural plexus: a venographic classification system to predict technical feasibility in cerebrospinal fluid-venous fistula embolization.
Federico Cagnazzo, Anne Ducros, Nicolas Lonjon, Francois-Louis Collemiche, Emmanuelle Le Bars, Liesjet E H van Dokkum, Vincent Costalat, Antonio Marrazzo
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引用次数: 0
Abstract
Background: Navigating the epidural plexus (EP) is a key step in transvenous embolization of cerebrospinal fluid-venous fistulas (CSFVFs) in spontaneous intracranial hypotension (SIH). However, no standard venographic classification currently exists to predict procedural complexity. This study proposes a venographic classification of the EP and evaluates its correlation with technical outcomes.
Methods: From November 2022 to May 2025, 85 patients underwent transvenous embolization for CSFVF. In 75 cases, detailed EP venography was available and categorized as: Type I (55%), homogeneous EP, Type II (34.5%), septated channels, and Type III (10.5%), complex, narrow pathways. Of the 75 cases with available EP venography, EP microcatheter navigation was performed in 65 cases: technical endpoints were extracted from these cases.
Results: Overall, embolization was technically successful in all cases. EP navigation was performed in 65/75 cases (87%), with a 91% success rate overall: highest in Type I (97.5%)-Type II (90%), and lowest in Type III (50%). Type III EPs were associated with longer fluoroscopy times per level (510 vs 60-70 s, p=0.0008) and a higher rate of EP perforation (66% vs 10% Type I and 0% Type II; p<0.001). EP navigation time per segment decreased over time, from 130 s (first year) to 60 s (after 24 months), reflecting a learning curve.
Conclusions: The proposed EP classification correlates with procedural complexity and outcomes. It may aid in preprocedural planning and improve the safety and efficiency of transvenous CSFVF embolization.
背景：在自发性颅内低血压（SIH）患者脑脊液-静脉瘘（CSFVFs）中，硬膜外神经丛（EP）导航是经静脉栓塞治疗的关键步骤。然而，目前尚无标准的静脉造影分类来预测手术的复杂性。本研究提出了一个静脉造影分类的EP和评估其与技术成果的相关性。方法：2022年11月至2025年5月，85例CSFVF患者行经静脉栓塞治疗。在75例患者中，可获得详细的EP静脉造影，并将其分类为：I型（55%），均质EP， II型（34.5%），分隔通道和III型（10.5%），复杂，狭窄的通道。在75例可获得EP静脉造影的病例中，65例进行了EP微导管导航：从这些病例中提取技术终点。结果：总的来说，栓塞术在技术上是成功的。EP导航在65/75例（87%）中进行，总体成功率为91%:I型最高（97.5%），II型（90%），III型最低（50%）。III型EPs与每层较长的透视时间（510 vs 60-70 s, p=0.0008）和较高的EP穿孔率（66% vs 10% I型和0% II型）相关。结论：建议的EP分类与手术复杂性和结果相关。有助于术前规划，提高经静脉CSFVF栓塞的安全性和有效性。
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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