背景:硬脑膜动静脉瘘(dAVF)是与大脑或脊柱中的硬脑膜脉管系统连通的动静脉分流器。除了单中心系列,儿童dAVF的危险因素和治疗结局在很大程度上没有描述.
方法:我们根据PRISMA指南对儿科(诊断时<18岁)颅内和脊髓dAVF进行了系统文献综述。我们询问PubMed,CINAHL,Scopus,和Embase数据库没有时间/日期限制。搜索字符串包括与硬脑膜房室瘘相关的各种MeSH关键字以及与儿科病例相关的MeSH关键字(见附录)。排除了描述诊断为硬脑膜窦畸形或静脉AVF的患者的手稿。
结果:我们确定了61项研究,描述了69例患者。总的来说,dAVF在男性中更常见(55.1%),平均诊断年龄(5.17±4.42岁)。约20.2%的患者出现心血管疾病(CVD),31.9%是在神经影像学研究中偶然发现的。横向乙状结肠交界处是最常见的位置(17.3%)。93%(64名患者)接受了治疗,最常使用血管内栓塞(68.1%),其次是手术(8.7%)和放射外科(2.9%).几乎一半(43.8%)的dAVF被完全消除。在64个程序中,有19种不同严重程度的神经系统并发症(29.7%),其中12.5%被认为是短暂的(即,假脑膜膨出)和17.2%的永久性(即,急性窦血栓形成继发死亡率,等。).
结论:关于小儿dAVF的信息很少。本系统综述总结了儿科人群中已发表的dAVF病例。虽然数据缺失率很高,有出版偏见,关于并发症的确切细节很难确定,本综述作为儿科dAVF的描述性总结.
BACKGROUND: Dural arteriovenous fistulas (dAVF) are arteriovenous shunts in communication with the dural vasculature in the brain or spine. Apart from single-center series, risk factors and treatment outcomes for pediatric dAVFs are largely undescribed.
METHODS: We performed a systematic literature review of pediatric (< 18 years at diagnosis) intracranial and spinal dAVF according to PRISMA guidelines. We queried PubMed, CINAHL, SCOPUS, and Embase databases without time/date restriction. Search strings included a variety of MeSH keywords relating to dural AV fistulas in combination with MeSH keywords related to pediatric cases (see Appendix). Manuscripts describing patients diagnosed with dural sinus malformations or pial AVF were excluded.
RESULTS: We identified 61 studies describing 69 individual patients. Overall, dAVF were more common in males (55.1%) with a mean age of diagnosis (5.17 ± 4.42 years). Approximately 20.2% of patients presented with cardiovascular disease (CVD), and 31.9% were discovered incidentally on neuroimaging studies. Transverse-sigmoid junction was the most common location (17.3%). Ninety-three percent (64 patients) were treated, most commonly using endovascular embolization (68.1%) followed by surgery (8.7%) and radiosurgery (2.9%). Almost half (43.8%) of dAVFs were completely obliterated. Of the 64 procedures, there were 19 neurological complications (29.7%) of varying severity where 12.5% were considered transient (i.e., pseudomeningocele) and 17.2% permanent (i.e., mortality secondary to acute sinus thrombosis, etc.).
CONCLUSIONS: There is a paucity of information on pediatric dAVFs. This systematic review summarizes the published cases of dAVFs in the pediatric population. While the rate of missing data is high, there is publication bias, and precise details regarding complications are difficult to ascertain, this review serves as a descriptive summary of pediatric dAVFs.