背景:脊髓血管畸形(SVM),包括动静脉畸形(AVM)和瘘(AVF),是一组可以根据定位进行细分的血管病变,血管结构,和血液动力学。早期干预对于阻止疾病进展和减少不可逆的功能障碍是必要的。我们试图描述各种类型的SVMs介入治疗后的初始治疗成功率和复发率。
方法:根据PRISMA指南进行系统评价和荟萃分析。SVM分为四组:硬脑膜AVF,髓周AVF,髓内AVM,和硬膜外-硬膜外AVM(例如,硬膜外,椎旁)。初始闭塞,复发,使用随机效应分析比较并发症发生率。
结果:包括112份手稿,共有5626名SVM患者。为了治疗,2735例患者行血管内栓塞术,2854手术切除,和37SRS。所有SVMs手术切除后的初始治疗成功率和总体复发率分别为89.5%(95%CI80.5-98.5%)和2.3%(95%CI0.9-3.7%),分别。血管内栓塞后的发生率为55.9%(95%CI30.3-81.5%)和27.7%(95%CI11.2-44.2%),分别。与栓塞相比,在所有亚型中观察到较高的初始治疗成功率和较低的手术复发率。对于每个SVM类别,栓塞后的总体并发症发生率较高。
结论:与血管内技术相比,手术切除SVMs提供了更高的初始完全闭塞率和更低的复发率。通过闭塞获得技术成功仍必须权衡特定血管畸形的临床影响和自然史。
Spinal vascular malformations (SVMs), including arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs), are a varied group of vascular lesions that can be subclassified according to localization, vascular structure, and hemodynamics. Early intervention is necessary to halt progression of disease and minimize irreversible dysfunction. We sought to characterize initial treatment success and recurrence rates following interventional treatment of various types of SVMs.
A systematic
review and meta-analysis were performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. SVMs were categorized into 4 groups: dural AVFs, perimedullary AVFs, intramedullary AVMs, and extradural-intradural AVMs (e.g., epidural, paraspinal). Initial occlusion, recurrence, and complication rates were compared using random-effects analysis.
There were 112 manuscripts included, with a total of 5626 patients with SVM. For treatment, 2735 patients underwent endovascular embolization, 2854 underwent surgical resection, and 37 underwent stereotactic radiosurgery. The initial treatment success and overall recurrence rates following surgical resection of all SVMs were 89.5% (95% CI: 80.5%-98.5%) and 2.3% (95% CI: 0.9%-3.7%), respectively. Those rates following endovascular embolization were 55.9% (95% CI: 30.3%-81.5%) and 27.7% (95% CI: 11.2%-44.2%), respectively. Higher rates of initial treatment success and lower rates of recurrence with surgery were observed in all subtypes compared to embolization. Overall complication rates were higher after embolization for each of the SVM categories.
Surgical resection of SVMs provided higher rates of initial complete occlusion and lower rates of recurrence than endovascular techniques. Attaining technical success through obliteration must still be weighed against clinical impact and natural history of the specific vascular malformation.