背景:硬脑膜颈动脉海绵窦瘘(dCCFs),也被称为间接颈动脉海绵窦瘘,代表海绵窦内动脉和静脉系统之间的异常连接,通常通过血管内途径治疗。我们旨在基于血管内治疗方法研究dCCF患者的临床特征,并评估血管造影和临床结果。
方法:对文献进行了系统综述。数据包括患者数量,人口统计,出现临床症状,瘘的病因,巴罗分类,收集和评估栓塞材料。收集的结果指标包括瘘管闭塞程度,术后症状,并发症,和平均随访时间。
结果:共纳入52项研究,检查了治疗dCCF的四种主要血管内途径:经动脉,经股动脉-经静脉(经骨或其他),经眶(经皮或经切),和直接面面接触。总体数据来自736例817dCCF患者。与通过岩下窦的经静脉技术(88.1%)相比,经动脉入路的dCCF闭塞率较低(75.6%)。通过直接穿刺或手术切除的经眶入路为海绵窦提供了更直接的路径,尽管有更大的并发症,包括眼眶血肿的风险。直接经面静脉入路,虽然有限,显示高达100%的闭塞率和最小的并发症。
结论:我们对dCCF的四种主要血管内途径进行了全面综述。总之,dCCF的现有血管内治疗方案已得到扩展,并提供了具有普遍良好结果的有效解决方案.虽然方法的选择取决于个体患者因素和技术可用性,传统的经静脉手术已成为一线血管内治疗.有成长,关于直接经眶和经面入路的有利文献;然而,需要更多的研究直接比较这些一般的经静脉治疗方案,以完善治疗策略.
BACKGROUND: Dural carotid-cavernous fistulas (dCCFs), also known as indirect carotid-cavernous fistulas, represent abnormal connections between the arterial and venous systems within the cavernous sinus that are typically treated via endovascular approach. We aim to investigate the clinical characteristics of patients with dCCFs based on the endovascular treatment approach and assess angiographic and clinical outcomes.
METHODS: A systematic review of the literature was performed. Data including number of patients, demographics, presenting clinical symptoms, etiology of fistula, Barrow classification, and embolization material were collected and evaluated. Outcome measures collected included degree of fistula occlusion, postoperative symptoms, complications, and mean follow-up time.
RESULTS: A total of 52 studies were included examining four primary endovascular approaches for treating dCCFs: transarterial, transfemoral-transvenous (transpetrosal or other), transorbital (percutaneous or via cutdown), and direct transfacial access. Overall data was collected from 736 patients with 817 dCCFs. Transarterial approaches exhibit lower dCCF occlusion rates (75.6%) compared to transvenous techniques via the inferior petrosal sinus (88.1%). The transorbital approach via direct puncture or surgical cutdown offers a more direct path to the cavernous sinus, although with greater complications including risk of orbital hematoma. The direct transfacial vein approach, though limited, shows up to 100% occlusion rates and minimal complications.
CONCLUSIONS: We provide a comprehensive review of four main endovascular approaches for dCCFs. In summary, available endovascular treatment options for dCCFs have expanded and provide effective solutions with generally favorable outcomes. While the choice of approach depends on individual patient factors and technique availability, traditional transvenous procedures have emerged as the first-line endovascular treatment. There is growing, favorable literature on direct transorbital and transfacial approaches; however, more studies directly comparing these general transvenous options are necessary to refine treatment strategies.