Morphological, clinical, and procedural determinants of embolization outcomes in non-cavernous cerebral dural arteriovenous fistulas: A retrospective study

IF 2.1 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2026-11-01 Epub Date: 2026-10-06 DOI:10.1016/j.jstrokecerebrovasdis.2026.108763

Luc Defreyne MD, PhD, Lynn Huyck MS, PhD, Peter Vanlangenhove MD, PhD1, Wouter De Coninck MD, Edward Baert MD PhD, Dimitri Hemelsoet MD, Elisabeth Dhondt MD, PhD

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引用次数: 0

Abstract

Purpose

The purpose of this retrospective study was to determine whether dAVF (dural arteriovenous fistula) characteristics influences treatment indication, embolization techniques, complications, radiation burden, and outcome.

Methods and Materials

Patients treated by embolization for a brain dAVF were included. Excluded were cavernous sinus and surgically treated dAVF. Patients’ demographics, clinical and treatment data were retrieved. dAVF clusters were formed: haemorrhagic versus non-haemorrhagic onset and sinus versus non-sinus type and impact on treatment indication, complications, radiation burden, functional and angiographic outcome was analyzed.

Results

In a study involving 119 dAVF in 115 patients, 33 patients (mean age 62 years ± 1.8, 72.7% males) presented with a haemorrhagic onset, while 82 (mean age 58 years ± 1.6, 57.3% females) exhibiting 86 dAVF had no bleeding. The sigmoid sinus was over-represented in the latter (52.3%), whereas a cerebrocortical occipital vein was frequently involved in the former group (27,3%). All but one haemorrhagic dAVF demonstrated a Borden-III classification. At six months, the prevalence of mRS class “0” was significantly higher in the non-haemorrhagic dAVF group (70.7% versus 32.3%) compared to the sinus-type clusters, where no such difference was observed. Six months angiography revealed occlusion in 88.2% of 102 catheterized fistulae, similar for all groups. Onyx volume and injection time was significantly higher in non-haemorrhagic and sinus-type dAVF. In non-haemorrhagic dAVF, fluoroscopy time (66.16 versus 40.48 minutes) and the number of acquisitions (68 versus 50) was significantly higher, but not radiation exposure. Although rare, mortality occurred only in sinus-type non-haemorrhagic dAVF. Facial nerve palsy was the major adverse event in non-haemorrhagic dAVF.

Conclusion

Employing comparable techniques, occluding non-haemorrhagic onset dAVF takes longer and requires a larger embolic volume, yet it presents a higher likelihood of achieving an excellent functional outcome. Occlusion rates are high in all dAVF clusters. Managing non-haemorrhagic, sinus-type dAVFs requires careful attention.

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非海绵状脑硬膜动静脉瘘栓塞结果的形态学、临床和手术决定因素：一项回顾性研究。

目的：本回顾性研究的目的是确定dAVF（硬脑膜动静脉瘘）特征是否影响治疗适应证、栓塞技术、并发症、放射负担和预后。方法和材料：采用栓塞治疗的脑dAVF患者。排除海绵窦和手术治疗的房颤。检索患者的人口统计学、临床和治疗数据。形成dAVF簇：分析出血性与非出血性、窦性与非窦性类型及其对治疗适应证、并发症、放射负担、功能和血管造影结果的影响。结果：在115例119 dAVF患者的研究中，33例患者（平均年龄62岁±1.8岁，男性72.7%）表现为出血，而82例（平均年龄58岁±1.6岁，女性57.3%）表现为86 dAVF无出血。乙状结肠窦在后者中被过度代表（52.3%），而脑皮质枕静脉在前者中经常受累（27.3%）。除一例出血性dAVF外，其余均为Borden-III型。在6个月时，非出血性dAVF组的mRS“0”级患病率明显高于窦型组（70.7%对32.3%），而窦型组没有观察到这种差异。6个月血管造影显示102例导管瘘中有88.2%闭塞，各组相似。在非出血性和窦型dAVF中，缟玛瑙的体积和注射时间明显增加。在非出血性dAVF中，透视时间（66.16分钟对40.48分钟）和采集次数（68分钟对50分钟）显着增加，但辐射暴露没有明显增加。虽然罕见，但死亡率仅发生在窦型非出血性房颤。面神经麻痹是非出血性dAVF的主要不良事件。结论：采用类似的技术，闭塞性非出血性dAVF需要更长的时间，需要更大的栓塞量，但它有更高的可能性获得良好的功能结果。所有dAVF集群的闭塞率都很高。处理非出血性窦型davf需要谨慎注意。

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

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.