目的:本研究旨在评估立体定向放射外科(SRS)治疗横乙状窦硬脑膜动静脉瘘(TSSDAVFs)的疗效和安全性,并调查SRS后的鼻窦通畅,重点关注与治疗鼻窦闭塞相关的危险因素。
方法:分析了2006年1月至2023年4月期间接受SRS治疗的34例患者的数据。在SRS之前使用数字减影血管造影确认了详细的血管结构。对同侧颈内动脉和椎动脉进行血管造影,以评估TSS的受累侧是否用于正常的静脉引流。TSS狭窄定义为窦直径<正常近端直径的50%。DAVF分流闭塞术,TSS闭塞,神经状况,并对不良事件进行了评估.
结果:在34例患者中,21人患有BordenI型,14人患有BordenII型DAVF。SRS的中位年龄为64岁(四分位距54-71岁),随访时间为31个月(四分位距15-94个月)。24例(70.6%)患者实现了完全分流闭塞。累计2-,3-,5年分流闭塞率为49.6%,71.2%,和86.0%,分别。BordenI型的闭塞率较高(60.5%,83.1%,94.4%,分别)比BordenII型(41.7%,51.4%,75.7%,分别为;p=0.034)。5例(14.7%)患者发生TSS闭塞。累计1-,5-,10年TSS闭塞率为2.9%,8.3%,和23.6%,分别,在整个队列中。所有闭塞仅发生在未用于正常静脉引流的鼻窦中。Cox比例分析表明,TSS狭窄和未用于正常静脉引流的窦与SRS后TSS闭塞的风险显着相关(HR9.44,95%CI1.01-77.13;p=0.049)。
结论:SRS对TSSDAVF是有效和安全的,并导致良好的分流闭塞,症状改善,并发症发生率低。SRS后的TSS闭塞无症状,仅限于不用于正常静脉引流的鼻窦。
This study aimed to assess the efficacy and safety of stereotactic radiosurgery (SRS) in treating transverse-sigmoid sinus dural arteriovenous fistulas (TSS DAVFs), and to investigate post-SRS sinus patency, focusing on the risk factors associated with treated sinus occlusion.
Data from 34 patients treated with SRS between January 2006 and April 2023 were analyzed. Detailed angioarchitecture was confirmed using digital subtraction angiography before SRS. Angiography of the ipsilateral internal carotid artery and vertebral artery was performed to evaluate whether the involved side of the TSS was used for normal venous drainage. TSS stenosis was defined as sinus diameter < 50% of the normal proximal diameter. DAVF shunt obliteration, TSS occlusion, neurological status, and adverse events were also evaluated.
Of the 34 patients, 21 had Borden type I and 14 had Borden type II DAVFs. The median age at SRS was 64 years (interquartile range 54-71 years), and the follow-up period was 31 months (interquartile range 15-94 months). Complete shunt obliteration was achieved in 24 (70.6%) patients. The cumulative 2-, 3-, and 5-year shunt obliteration rates were 49.6%, 71.2%, and 86.0%, respectively. Borden type I had higher obliteration rates (60.5%, 83.1%, and 94.4%, respectively) than Borden type II (41.7%, 51.4%, and 75.7%, respectively; p = 0.034). TSS occlusion occurred in 5 patients (14.7%). The cumulative 1-, 5-, and 10-year TSS occlusion rates were 2.9%, 8.3%, and 23.6%, respectively, across the entire cohort. All occlusions occurred exclusively in the sinuses that were not used for normal venous drainage. Cox proportional analyses revealed that TSS stenosis and the sinus not being used for normal venous drainage were significantly associated with a greater risk of TSS occlusion after SRS (HR 9.44, 95% CI 1.01-77.13; p = 0.049).
SRS is effective and safe for TSS DAVF and results in favorable shunt obliteration, symptom improvement, and low complication rates. TSS occlusion after SRS is asymptomatic and is limited to sinuses that are not used for normal venous drainage.