Abstract：
BACKGROUND: Clip ligation of anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) is the traditionally accepted first-line treatment. Endovascular treatment for ACF DAVFs may achieve good outcomes as endovascular techniques advance. Here we report the clinical and angiographic outcomes in patients with ACF DAVFs who underwent transarterial embolization (TAE) as first-line treatment.
METHODS: Over a 20-year period, 87.0% (40/46) of patients received TAE as first-line treatment. The clinical presentation, angiographic features, treatment strategy, and clinical and angiographic outcomes are described in this article.
RESULTS: Forty patients underwent TAE as first-line treatment. There were 36 men and 4 women, with a mean age of 55.6 (55.6±7.4) years. A total of 64 embolization attempts were performed. The middle meningeal artery (66.7%, 12/18) and the ophthalmic artery (54.2%, 13/24) were the most frequently used arterial access routes for complete embolization. The second option was the sphenopalatine artery (46.7%, 7/15). Complications, that is, retinal ischemia, occurred in one patient (2.5%). The total immediate complete occlusion rate for TAE was 82.5% (33/40). Two patients needed surgery for incomplete embolization. When followed up (90%, 36/40), one patient (2.8%, 1/36) reported worsening symptoms due to retinal ischemia following TAE. Although fewer than 50% of the patients received digital subtraction angiography follow-up, there were no recurrences.
CONCLUSIONS: We show that TAE is safe and effective in the treatment of ACF DAVFs in this study of 40 patients, making it a viable alternative to surgical ligation and transvenous embolization. More research is needed to compare these various treatment modalities.
METHODS: Over a 20-year period, 87.0% (40/46) of patients received TAE as first-line treatment. The clinical presentation, angiographic features, treatment strategy, and clinical and angiographic outcomes are described in this article.
RESULTS: Forty patients underwent TAE as first-line treatment. There were 36 men and 4 women, with a mean age of 55.6 (55.6±7.4) years. A total of 64 embolization attempts were performed. The middle meningeal artery (66.7%, 12/18) and the ophthalmic artery (54.2%, 13/24) were the most frequently used arterial access routes for complete embolization. The second option was the sphenopalatine artery (46.7%, 7/15). Complications, that is, retinal ischemia, occurred in one patient (2.5%). The total immediate complete occlusion rate for TAE was 82.5% (33/40). Two patients needed surgery for incomplete embolization. When followed up (90%, 36/40), one patient (2.8%, 1/36) reported worsening symptoms due to retinal ischemia following TAE. Although fewer than 50% of the patients received digital subtraction angiography follow-up, there were no recurrences.
CONCLUSIONS: We show that TAE is safe and effective in the treatment of ACF DAVFs in this study of 40 patients, making it a viable alternative to surgical ligation and transvenous embolization. More research is needed to compare these various treatment modalities.
摘要：
背景：前颅窝（ACF）硬脑膜动静脉瘘（DAVF）的钳夹结扎术是传统上公认的一线治疗方法。随着血管内技术的进步，ACFDAVFs的血管内治疗可能会取得良好的效果。在这里，我们报告了经动脉栓塞（TAE）作为一线治疗的ACFDAVFs患者的临床和血管造影结果。
方法：在20年的时间里，87.0%(40/46)的患者接受TAE作为一线治疗。临床表现，血管造影特征，治疗策略,本文描述了临床和血管造影结果。
结果：40例患者接受TAE作为一线治疗。有36名男性和4名女性，平均年龄55.6（55.6±7.4）岁。总共进行了64次栓塞尝试。脑膜中动脉（66.7%，12/18）和眼动脉（54.2%，13/24）是用于完全栓塞的最常用的动脉入路。第二种选择是蝶腭动脉(46.7%，7/15).并发症,也就是说,视网膜缺血,1例患者（2.5%）。TAE的总即刻完全闭塞率为82.5%(33/40)。两名患者因不完全栓塞需要手术。随访时(90%，36/40),一名患者(2.8%，1/36）报告TAE后由于视网膜缺血导致症状恶化。虽然不到50%的患者接受了数字减影血管造影随访,没有复发。
结论：我们表明，在这项40例患者的研究中，TAE治疗ACFDAVFs是安全有效的，使其成为手术结扎和经静脉栓塞的可行替代方案。需要更多的研究来比较这些不同的治疗方式。
方法：在20年的时间里，87.0%(40/46)的患者接受TAE作为一线治疗。临床表现，血管造影特征，治疗策略,本文描述了临床和血管造影结果。
结果：40例患者接受TAE作为一线治疗。有36名男性和4名女性，平均年龄55.6（55.6±7.4）岁。总共进行了64次栓塞尝试。脑膜中动脉（66.7%，12/18）和眼动脉（54.2%，13/24）是用于完全栓塞的最常用的动脉入路。第二种选择是蝶腭动脉(46.7%，7/15).并发症,也就是说,视网膜缺血,1例患者（2.5%）。TAE的总即刻完全闭塞率为82.5%(33/40)。两名患者因不完全栓塞需要手术。随访时(90%，36/40),一名患者(2.8%，1/36）报告TAE后由于视网膜缺血导致症状恶化。虽然不到50%的患者接受了数字减影血管造影随访,没有复发。
结论：我们表明，在这项40例患者的研究中，TAE治疗ACFDAVFs是安全有效的，使其成为手术结扎和经静脉栓塞的可行替代方案。需要更多的研究来比较这些不同的治疗方式。
