<br>颅颈交界处硬脑膜动静脉瘘的增强治疗选择：血管内栓塞与显微手术？单中心23年经验,World Neurosurgery

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颅颈交界处硬脑膜动静脉瘘的增强治疗选择：血管内栓塞与显微手术？单中心23年经验
World Neurosurgery ( IF 1.9 ) Pub Date : 2023-11-30 , DOI: 10.1016/j.wneu.2023.11.116
Jiebo Li ₁ , Fuxin Lin ₂ , Jianyu Zhu ₁ , Lingyun Zhuo ₁ , Fuxiang Chen ₃ , Linsun Dai ₃ , Shufa Zheng ₃ , Lianghong Yu ₃ , Dezhi Kang ₂ , Yuanxiang Lin ₃ , Dengliang Wang ₃

Affiliation

颅颈交界处（CCJ）发生硬脑膜动静脉瘘（DAVF）是一种罕见的血管畸形。 CCJ DAVF 的诊断和治疗提出了巨大的挑战。本研究旨在探讨血管内栓塞和显微手术对改善患者预后的效果。本回顾性研究纳入2000年1月至2023年1月期间在福建医科大学附属第一医院接受治疗的CCJ DAVF患者。临床记录、影像学数据和治疗方法均从医院病历系统中获取。根据治疗所采用的手术技术将患者分为显微手术组和栓塞组。主要结局指标是手术相关的神经功能障碍（SAND）和长期神经系统结局。利用 Cox 比例风险回归确定风险比和 95% 置信区间 (CI)，以评估治疗方法与预后之间的关系。采用 Kaplan-Meier 生存分析来评估两个队列中 SAND 的发生率。本研究招募了 46 名患者，平均年龄为 53.72 ± 13.83 岁。显微手术组共观察12例（26.1%）。栓塞组34例（73.9%）。这些患者中，16 名（34.8%）在治疗后出现 SAND。显微手术组有8例（75.0%），而栓塞组仅有8例（23.5%）。具体而言，栓塞组的 SAND 风险显着降低[调整后风险比 = 0.259，95% CI = 0.096–0.700； = 0.008)]与显微手术组相比。此外，发现合并的 Borden 2-3 级与 SAND 显着相关（调整后的风险比 = 3.150，95% CI = 1.132-8.766；= 0.028）。 Kaplan-Meier 生存分析的结果表明，两组之间良好功能结果的发生率存在统计学显着差异（对数秩 = 0.0081）。 CCJ DAVF 是一种罕见疾病，具有多种临床表现。血管内治疗的功能预后可能优于显微手术。

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Enhanced Treatment Options for Dural Arteriovenous Fistulas at the Craniocervical Junction: Endovascular Embolization Versus Microsurgery? A Single-Center 23-Year Experience

The occurrence of dural arteriovenous fistulas (DAVFs) at the craniocervical junction (CCJ) is an uncommon vascular malformation. The diagnosis and treatment of CCJ DAVFs present a formidable challenge. This study aims to investigate the effect of endovascular embolization and microsurgery on improving patient prognosis. This retrospective study included patients diagnosed with CCJ DAVFs who received treatment at the First Affiliated Hospital of Fujian Medical University between January 2000 and January 2023. The clinical records, imaging data, and treatment methods were obtained from the hospital's medical record system. The patients were classified into microsurgery and embolization groups based on the surgical technique employed for treatment. The primary outcome measures were surgical-associated neurological dysfunction (SAND) and long-term neurological outcomes. The Cox proportional hazard regression was utilized to determine hazard ratios and 95% confidence intervals (CI) to assess the relationship between treatment methods and prognosis. Kaplan-Meier survival analysis was employed to evaluate the incidence of SAND in both cohorts. This study recruited 46 patients with an average age of 53.72 ± 13.83 years. In the microsurgery group, there were 12 cases (26.1%) observed. While in the embolization group, there were 34 cases (73.9%). Of these patients, 16 (34.8%) experienced SAND after treatment. In the microsurgery group, there were 8 cases (75.0%), while in the embolization group, only 8 cases (23.5%) were reported. Specifically, the embolization group exhibited a significantly lower risk of SAND [adjusted hazard ratio = 0.259, 95% CI = 0.096–0.700; = 0.008)] compared to the microsurgery group. Additionally, the combined Borden grade 2–3 was found to be significantly associated with SAND (adjusted hazard ratio = 3.150, 95% CI = 1.132–8.766; = 0.028). The results of the Kaplan-Meier survival analysis indicated a statistically significant difference in the occurrence of favorable functional outcomes between the 2 groups (log-rank = 0.0081). CCJ DAVFs are uncommon disorders characterized by a diverse range of clinical manifestations. The functional prognosis of endovascular treatment may be superior to microsurgery.

更新日期：2023-11-30

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