基于血管构筑的颅内硬脑膜动静脉瘘血管内治疗后的长期结局：一项来自德国的单中心队列研究

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中文摘要

目的： 血管内治疗是颅内硬脑膜动静脉瘘（dAVF）的既定选择，其疗效已在单中心和多中心队列中得到证实。在本研究中，我们批判性评估本中心采用标准化血管内治疗策略的经验，评价血管造影成功率、复发、安全性及长期结局。
方法： 我们回顾性分析2014年1月至2019年10月在德国法兰克福大学医院神经放射学研究所接受血管内治疗的颅内dAVF患者；排除直接型颈动脉海绵窦瘘。瘘管按Cognard分级，海绵窦dAVF另按Barrow分级。治疗基于血管构筑和可及性，采用经动脉液体栓塞和/或经静脉弹簧圈。结局包括血管造影成功、并发症、复发/再治疗及症状演变，资料来自病历、随访和结构化电话访谈；患者报告的临床随访中位时间为53个月。
结果： 共纳入55例患者。Cognard I/IIa/IIa+b/IIb/III/IV/V分布为6/10/1/13/16/8/1；39/55为高级别。22例记录到明确的静脉/窦血栓形成。9例发生初始出血，并与高风险引流（8/22 vs 1/33；p=0.0017）和高级别Cognard病变（9/39 vs 0/16；p=0.046）相关。栓塞在49例实现完全闭塞；另有3例存在残留Cognard I型分流，使血管造影成功达52/55例。发生1例复发、3例临床并发症和1例技术并发症。患者报告改善46/50；耳鸣改善最明显，而复视在2/6例中持续存在。
结论： 本单中心研究提供了对本机构治疗策略的真实世界评价。我们的发现支持其可行性，但该队列规模小且异质性大，限制了对治疗疗效和持久性的更广泛结论。

英文摘要

PURPOSE: Endovascular treatment is an established option for cranial dural arteriovenous fistulas (dAVFs), and its efficacy has been demonstrated in single-center and multicenter cohorts. In this study, we critically evaluate our single-center experience with a standardized endovascular treatment strategy, assessing angiographic success, recurrence, safety, and long-term outcomes.
METHODS: We retrospectively analyzed patients treated endovascularly for cranial dAVFs from January 2014 to October 2019 at the Institute for Neuroradiology, University Hospital Frankfurt, Germany; direct carotid-cavernous fistulas were excluded. Fistulas were Cognard-classified, cavernous-sinus dAVFs additionally Barrow-classified. Treatment was based on angioarchitecture and accessibility, using transarterial liquid embolization and/or transvenous coils. Outcomes included angiographic success, complications, recurrence/retreatment, and symptom evolution from records, follow-up, and structured telephone interviews; median patient-reported clinical follow-up was 53 months.
RESULTS: Fifty-five patients were included. Cognard I/ IIa/ IIa + b/ IIb/ III/ IV/ V distribution was 6/10/1/13/16/8/1; 39/55 were high-grade. Definite venous/sinus thrombosis was documented in 22. Initial hemorrhage occurred in 9 and was associated with high-risk drainage (8/22 vs 1/33; p=0.0017) and high-grade Cognard lesions (9/39 vs 0/16; p=0.046). Embolization achieved complete occlusion in 49 cases; three additional patients had residual Cognard type I shunting, resulting in angiographic success in 52/55 patients. One recurrence, three clinical complications, and one technical complication occurred. Patient-reported improvement occurred in 46/50; tinnitus improved most, whereas diplopia persisted in 2/6 cases.
CONCLUSION: This single-center study provides a real-world evaluation of our institutional treatment strategy. Our findings support its feasibility, while the small, heterogeneous cohort limits broader conclusions regarding treatment efficacy and durability.