Dural arteriovenous fistulas at the craniocervical junction: a systematic review and meta-analysis.

IF 2.5 3区医学 Q2 CLINICAL NEUROLOGY Neurosurgical Review Pub Date : 2024-10-23 DOI:10.1007/s10143-024-03018-3

Jumanah Qedair, Kiran Sankarappan, Mohammad Mirahmadi Eraghi, Zachary C Gersey, Prateek Agarwal, Sharath Kumar Anand, Paolo Palmisciano, Matthew Blackwell, Seyed Farzad Maroufi, Salah G Aoun, Tarek Y El Ahmadieh, Aaron A Cohen-Gadol, Othman Bin-Alamer

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Abstract

Background: The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management.

Methods: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes.

Results: We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2-64.5), 58.8 years (95%CI: 48.4-69.2), and 63.8 years (95%CI: 60.1-67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3-88.2%) in the microsurgery group and 54.9% (95%CI:30.7-77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7-34.5%) in the embolization group, 11.6% (95%CI:3.8-30.4%) in the microsurgery group, and 7.7% (95%CI:1.1-39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1-80.8%), embolization: 51.9% (95%CI:30.8-72.4%), and conservative: 11.6% (95%CI:4.4-27.4%)].

Conclusions: In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics.

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颅颈交界处的硬脑膜动静脉瘘：系统回顾和荟萃分析。

背景：颅颈交界处硬脑膜动静脉瘘（CCJ-DAVFs）的治疗仍存在争议，在临床上具有挑战性。我们系统总结了显微手术、栓塞术和保守治疗的临床和血管造影结果：按照 PRISMA 指南，从 PubMed、Scopus、Web of Science 和 Cochrane 检索相关文章。结果：我们纳入了 13 篇文章（166 名患者）：我们共纳入了 13 篇文章（166 名患者）。显微手术组、栓塞组和保守治疗组的加权平均年龄分别为 58.9 岁（95%CI：53.2-64.5）、58.8 岁（95%CI：48.4-69.2）和 63.8 岁（95%CI：60.1-67.5），总体上男性占多数（显微手术[n = 51/77，66.2%]、栓塞[n = 44/56，78.6%]和保守治疗[n = 6/8，75.0%]）。患者接受显微手术治疗（80/172，46.5%）、栓塞治疗（79/172，45.9%）和保守治疗（13/172，7.6%）。枕骨大孔是最常见的位置（显微手术[n = 34/77，44.2%]、栓塞[n = 31/56，55.4%]和保守治疗[n = 3/8，37.5%]）。椎动脉是主要供血动脉（显微手术[n = 58/84，69.1%]、栓塞[n = 41/86，47.6%]和保守治疗[n = 4/7，57.1%]）。显微手术组的瘘管完全阻塞率为 74.1%（95%CI：52.3-88.2%），栓塞组为 54.9%（95%CI：30.7-77.0%）。栓塞组的并发症发生率为 16.2% (95%CI:6.7-34.5%)，显微手术组为 11.6% (95%CI:3.8-30.4%)，保守治疗组为 7.7% (95%CI:1.1-39.1%)。观察到了不同的良好临床结果率[显微手术组：66.4%（95%CI：1.1-39.166.4%（95%CI:48.1-80.8%），栓塞术：结论：对于CCJ-DAVFs患者，根据瘘管和患者特征，每种治疗方法都有其自身的优点。

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

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.