Abstract：
Anterior cranial fossa dural arteriovenous fistulas (DAVFs) have been almost exclusively considered as surgical lesions. However, new advances in endovascular technology have made the endovascular treatment (EVT) of ethmoidal DAVFs feasible. The aim of this study was to report the clinical and angiographic outcomes of patients harboring DAVFs of the anterior cranial fossa who had undergone EVT as a first-line approach.
This was a retrospective study of a consecutive series of patients harboring anterior cranial base DAVFs who had undergone EVT as a first-line approach at four institutions. Angiographic follow-up was performed at 6 months. Immediate and late serious clinical events were assessed during follow-up, including death and stroke. Special emphasis was given to visual status before and after the treatment.
Between 2008 and 2020, 37 patients with ethmoidal DAVFs were admitted to the participating centers. In 2 patients, EVT was not attempted; therefore, 35 patients underwent EVT as a first-line procedure. An isolated transarterial approach was performed in 19 (54.3%) patients. The transvenous approach was performed exclusively in 12 (34.3%) patients, and combined access was used in 4 (11.4%) patients. The most frequently used arterial access route was the ophthalmic artery in 82.6% of the patients. Immediately, complete angiographic occlusion was achieved in 31 (91.2%) of 34 patients whose treatment was accomplished. Six-month control angiography revealed that 30 (88.2%) DAVFs were totally occluded. Complications occurred in 3 (8.8%) patients, including 1 (2.9%) patient who had central retinal artery occlusion. No significant difference in complications or occlusion rates was noted between the transarterial and transvenous approaches.
Most anterior cranial base DAVFs can be successfully treated via an endovascular approach. Neurological and visual complications are rare, even if the ophthalmic artery is used as the primary access route. Efforts should be focused on prospectively comparing the results of EVT and surgical management.
This was a retrospective study of a consecutive series of patients harboring anterior cranial base DAVFs who had undergone EVT as a first-line approach at four institutions. Angiographic follow-up was performed at 6 months. Immediate and late serious clinical events were assessed during follow-up, including death and stroke. Special emphasis was given to visual status before and after the treatment.
Between 2008 and 2020, 37 patients with ethmoidal DAVFs were admitted to the participating centers. In 2 patients, EVT was not attempted; therefore, 35 patients underwent EVT as a first-line procedure. An isolated transarterial approach was performed in 19 (54.3%) patients. The transvenous approach was performed exclusively in 12 (34.3%) patients, and combined access was used in 4 (11.4%) patients. The most frequently used arterial access route was the ophthalmic artery in 82.6% of the patients. Immediately, complete angiographic occlusion was achieved in 31 (91.2%) of 34 patients whose treatment was accomplished. Six-month control angiography revealed that 30 (88.2%) DAVFs were totally occluded. Complications occurred in 3 (8.8%) patients, including 1 (2.9%) patient who had central retinal artery occlusion. No significant difference in complications or occlusion rates was noted between the transarterial and transvenous approaches.
Most anterior cranial base DAVFs can be successfully treated via an endovascular approach. Neurological and visual complications are rare, even if the ophthalmic artery is used as the primary access route. Efforts should be focused on prospectively comparing the results of EVT and surgical management.
摘要：
前颅窝硬脑膜动静脉瘘（DAVF）几乎被认为是外科病变。然而,血管内技术的新进展使筛骨DAVFs的血管内治疗（EVT）变得可行。这项研究的目的是报告接受EVT作为一线方法的前颅窝DAVF患者的临床和血管造影结果。
这是一项回顾性研究，对在四个机构接受EVT作为一线方法治疗的连续一系列具有前颅基础DAVF的患者进行了回顾性研究。随访6个月。随访期间评估即时和晚期严重临床事件，包括死亡和中风.特别强调治疗前后的视觉状态。
在2008年至2020年之间，37例筛骨DAVF患者被纳入参与中心。在2名患者中，没有尝试EVT；因此，35例患者接受EVT作为一线手术。对19例（54.3％）患者进行了孤立的经动脉入路。12例（34.3％）患者仅进行了经静脉入路，4例(11.4%)患者使用了联合通路。在82.6％的患者中，最常用的动脉入路是眼动脉。立刻,在完成治疗的34例患者中,有31例(91.2%)实现了血管造影完全闭塞.六个月的对照血管造影显示30（88.2％）DAVF完全闭塞。3例（8.8%）患者出现并发症，包括1例(2.9%)视网膜中央动脉阻塞患者。经动脉和经静脉途径的并发症或闭塞率没有显着差异。
大多数前颅底DAVFs可以通过血管内入路成功治疗。神经和视觉并发症很少见，即使眼动脉被用作主要通路。应集中精力前瞻性地比较EVT和手术治疗的结果。
这是一项回顾性研究，对在四个机构接受EVT作为一线方法治疗的连续一系列具有前颅基础DAVF的患者进行了回顾性研究。随访6个月。随访期间评估即时和晚期严重临床事件，包括死亡和中风.特别强调治疗前后的视觉状态。
在2008年至2020年之间，37例筛骨DAVF患者被纳入参与中心。在2名患者中，没有尝试EVT；因此，35例患者接受EVT作为一线手术。对19例（54.3％）患者进行了孤立的经动脉入路。12例（34.3％）患者仅进行了经静脉入路，4例(11.4%)患者使用了联合通路。在82.6％的患者中，最常用的动脉入路是眼动脉。立刻,在完成治疗的34例患者中,有31例(91.2%)实现了血管造影完全闭塞.六个月的对照血管造影显示30（88.2％）DAVF完全闭塞。3例（8.8%）患者出现并发症，包括1例(2.9%)视网膜中央动脉阻塞患者。经动脉和经静脉途径的并发症或闭塞率没有显着差异。
大多数前颅底DAVFs可以通过血管内入路成功治疗。神经和视觉并发症很少见，即使眼动脉被用作主要通路。应集中精力前瞻性地比较EVT和手术治疗的结果。
