Basel Musmar , Joanna M. Roy , Atakan Orscelik , Sravanthi Koduri , Spyridon Karadimas , Saman Sizdahkhani , Elias Atallah , Stavropoula I. Tjoumakaris , Michael Reid Gooch , Hekmat Zarzour , Ritam Ghosh , Richard F. Schmidt , Robert H. Rosenwasser , Pascal Jabbour
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PubMed, Scopus, and Web of Science databases were searched from inception to July 2024.</div></div><div><h3>Results</h3><div>Fifteen studies involving 266 patients were included. Of these, 143 (53.8 %) patients underwent surgical treatment alone and 123 (46.2 %) underwent endovascular treatment alone. In the surgical group, the complete obliteration rate at last follow-up was 89.8 %. Retreatment rate was 6.2 %. Periprocedural complications occurred in 21.6 % of cases. In the endovascular group, the complete occlusion rate at last follow-up was 73.6 %. Retreatment rate was 46.7 %. Periprocedural complications occurred in 18.8 % of cases. Comparative meta-analysis revealed that the rate of complete obliteration at last follow-up was significantly higher in the surgical group (OR: 0.24; CI: 0.07 to 0.89, <em>p</em> = 0.03). Surgical treatment had a significantly higher successful treatment rate (OR: 0.24; CI: 0.07 to 0.89, p = 0.03) and lower retreatment rate (OR: 37.13; CI: 6.31 to 218.59, <em>p</em> < 0.01). No significant differences were observed between the groups in terms of periprocedural complications or complete resolution of symptoms.</div></div><div><h3>Conclusion</h3><div>Surgical treatment for CCJ-DAVFs achieves higher rates of complete obliteration with lower retreatment rates compared to endovascular treatment. However, endovascular treatment showed a tendency towards reducing periprocedural complications while increasing the likelihood of complete resolution of symptoms. Individualized treatment plans for CCJ-DAVFs, should be considered according to their anatomical location and potential surgical accessibility. Further studies are required to confirm these findings.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"470 ","pages":"Article 123402"},"PeriodicalIF":3.2000,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative outcomes of endovascular vs. surgical treatment in craniocervical junction dural arteriovenous fistulas: A systematic review and meta-analysis\",\"authors\":\"Basel Musmar , Joanna M. Roy , Atakan Orscelik , Sravanthi Koduri , Spyridon Karadimas , Saman Sizdahkhani , Elias Atallah , Stavropoula I. Tjoumakaris , Michael Reid Gooch , Hekmat Zarzour , Ritam Ghosh , Richard F. Schmidt , Robert H. Rosenwasser , Pascal Jabbour\",\"doi\":\"10.1016/j.jns.2025.123402\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) are rare and complex vascular malformations that are challenging to diagnose and treat. This study aims to compare surgical and endovascular treatments for CCJ-DAVFs through a systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched from inception to July 2024.</div></div><div><h3>Results</h3><div>Fifteen studies involving 266 patients were included. Of these, 143 (53.8 %) patients underwent surgical treatment alone and 123 (46.2 %) underwent endovascular treatment alone. In the surgical group, the complete obliteration rate at last follow-up was 89.8 %. Retreatment rate was 6.2 %. Periprocedural complications occurred in 21.6 % of cases. In the endovascular group, the complete occlusion rate at last follow-up was 73.6 %. Retreatment rate was 46.7 %. Periprocedural complications occurred in 18.8 % of cases. Comparative meta-analysis revealed that the rate of complete obliteration at last follow-up was significantly higher in the surgical group (OR: 0.24; CI: 0.07 to 0.89, <em>p</em> = 0.03). Surgical treatment had a significantly higher successful treatment rate (OR: 0.24; CI: 0.07 to 0.89, p = 0.03) and lower retreatment rate (OR: 37.13; CI: 6.31 to 218.59, <em>p</em> < 0.01). No significant differences were observed between the groups in terms of periprocedural complications or complete resolution of symptoms.</div></div><div><h3>Conclusion</h3><div>Surgical treatment for CCJ-DAVFs achieves higher rates of complete obliteration with lower retreatment rates compared to endovascular treatment. However, endovascular treatment showed a tendency towards reducing periprocedural complications while increasing the likelihood of complete resolution of symptoms. Individualized treatment plans for CCJ-DAVFs, should be considered according to their anatomical location and potential surgical accessibility. Further studies are required to confirm these findings.</div></div>\",\"PeriodicalId\":17417,\"journal\":{\"name\":\"Journal of the Neurological Sciences\",\"volume\":\"470 \",\"pages\":\"Article 123402\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-03-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Neurological Sciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022510X2500019X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Neurological Sciences","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022510X2500019X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/21 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：颅颈交界处硬脑膜动静脉瘘（ccj - davf）是一种罕见而复杂的血管畸形，诊断和治疗具有挑战性。本研究旨在通过系统综述和荟萃分析，比较ccj - davf的手术治疗和血管内治疗。方法：根据PRISMA指南进行系统评价和荟萃分析。检索了PubMed， Scopus和Web of Science数据库，从创建到2024年7月。结果：纳入15项研究，共266例患者。其中，143例（53.8%）患者单独接受手术治疗，123例（46.2%）患者单独接受血管内治疗。手术组末次随访完全闭塞率为89.8%。再治疗率为6.2%。围手术期并发症发生率为21.6%。血管内组最后一次随访完全闭塞率为73.6%。再治疗率为46.7%。围手术期并发症发生率为18.8%。对比荟萃分析显示，最后一次随访时，手术组的完全闭塞率显著高于手术组(OR: 0.24；CI: 0.07 ~ 0.89, p = 0.03)。手术治疗的成功率明显高于手术治疗(OR: 0.24；CI: 0.07 ~ 0.89, p = 0.03)和较低的再处理率(OR: 37.13；结论：与血管内治疗相比，手术治疗ccj - davf具有更高的完全闭塞率和更低的再治疗率。然而，血管内治疗倾向于减少围手术期并发症，同时增加症状完全解决的可能性。ccj - davf的个体化治疗方案应根据其解剖位置和可能的手术可及性进行考虑。需要进一步的研究来证实这些发现。
Comparative outcomes of endovascular vs. surgical treatment in craniocervical junction dural arteriovenous fistulas: A systematic review and meta-analysis
Background
Craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) are rare and complex vascular malformations that are challenging to diagnose and treat. This study aims to compare surgical and endovascular treatments for CCJ-DAVFs through a systematic review and meta-analysis.
Methods
A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched from inception to July 2024.
Results
Fifteen studies involving 266 patients were included. Of these, 143 (53.8 %) patients underwent surgical treatment alone and 123 (46.2 %) underwent endovascular treatment alone. In the surgical group, the complete obliteration rate at last follow-up was 89.8 %. Retreatment rate was 6.2 %. Periprocedural complications occurred in 21.6 % of cases. In the endovascular group, the complete occlusion rate at last follow-up was 73.6 %. Retreatment rate was 46.7 %. Periprocedural complications occurred in 18.8 % of cases. Comparative meta-analysis revealed that the rate of complete obliteration at last follow-up was significantly higher in the surgical group (OR: 0.24; CI: 0.07 to 0.89, p = 0.03). Surgical treatment had a significantly higher successful treatment rate (OR: 0.24; CI: 0.07 to 0.89, p = 0.03) and lower retreatment rate (OR: 37.13; CI: 6.31 to 218.59, p < 0.01). No significant differences were observed between the groups in terms of periprocedural complications or complete resolution of symptoms.
Conclusion
Surgical treatment for CCJ-DAVFs achieves higher rates of complete obliteration with lower retreatment rates compared to endovascular treatment. However, endovascular treatment showed a tendency towards reducing periprocedural complications while increasing the likelihood of complete resolution of symptoms. Individualized treatment plans for CCJ-DAVFs, should be considered according to their anatomical location and potential surgical accessibility. Further studies are required to confirm these findings.
期刊介绍：
The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials).
JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.
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