目的:累及岩上静脉的硬脑膜动静脉瘘(SPVDAVF)极为罕见。因此,其临床表现,成像特性,治疗方法,和风险因素仍不清楚。在这项研究中,我们讨论和分析了SPVDAVF的上述特征。
方法:我们回顾性分析了30例SPVDAVFs患者,1年随访率为96.67%(29/30)。采用改良的Aminoff-Logue量表和改良的Rankin量表评分对患者的神经功能进行评估。采用单因素和多因素logistic回归分析确定治疗前后的危险因素。此外,提出了涉及3种不同SPVDAVF引流模式的治疗方法。
结果:在30名患者中,男性24人(80.0%)。此外,术后12个月复查血管造影图像.单因素分析表明,水肿程度(比值比1.889,95%置信区间1.132-3.154)和引流静脉数(≤2)(比值比10.833,95%置信区间1.961-59.834)是治疗前改良Rankin量表评分≥3的危险因素。然而,多因素分析显示差异无统计学意义(P=0.051,P=0.055)。在多变量分析之后,发现类固醇脉冲(比值比12.15395%置信区间1.080-136.772)是治疗前和1年随访改良Rankin量表评分≥2之间治疗后差异的唯一显著危险因素.
结论:采用SPV引流的DAVF是一种少见的颅内血管畸形。大多数病变涉及脑干或颈脊髓高位,从而带来更高的残疾或死亡风险。此外,持续性静脉高压引起的神经元损伤是永久性的。因此,准确的诊断和及时的治疗是患者良好预后的关键。
A dural arteriovenous fistula involving the superior petrosal vein (SPV DAVF) is an extremely rare condition. Therefore, its clinical presentation, imaging characteristics, treatment methods, and risk factors remain unclear. In this study, we discuss and analyze the aforementioned features of an SPV DAVF.
We retrospectively reviewed 30 patients with SPV DAVFs, with a 1-year follow-up rate of 96.67% (29 of 30). The neurological function of the patients was assessed using the modified Aminoff-Logue scale and the modified Rankin Scale score. The risk factors before and after treatment were established using univariate and multivariate logistic regression analyses. Additionally, treatments involving 3 distinct SPV DAVF drainage patterns were presented.
Of the 30 patients, 24 were men (80.0%). Besides, the angiography images were reexamined 12 months after surgery. Univariate analyses indicated that the extent of edema (odds ratio 1.889, 95% confidence interval 1.132-3.154) and the number of draining veins (≤2) (odds ratio 10.833, 95% confidence interval 1.961-59.834) were risk factors for pretreatment modified Rankin Scale score ≥3. However, multivariate analyses revealed no statistically significant differences (P = 0.051, P = 0.055). Following the multivariate analyses, steroid pulse (odds ratio 12.153 95% confidence interval 1.080-136.772) was found to be the only significant risk factor for post-treatment difference between pretreatment and 1-year follow-up modified Rankin Scale score ≥2.
A DAVF with SPV drainage is an uncommon type of intracranial vascular malformation. Most lesions involve the brain stem or high cervical spinal cord, thereby posing a higher risk of disability or death. Moreover, neuronal damage from persistent venous hypertension is permanent. Therefore, precise diagnosis and timely treatment are key to a good patient prognosis.