前颅窝(ACF)的硬脑膜动静脉瘘(dAVF)并不常见,但出血的风险很高,并且对治疗提出了很大的挑战。血管内治疗(EVT)的最新进展,包括引入新型液体栓塞剂,显著增强了EVT在管理ACF-dAVF中的作用,在过去的五年中出版了著名的系列。我们的目的是评估可行性,安全,EVT对ACF-dAVF的疗效。我们搜查了Medline,Scopus,WebofScience,和Cochrane图书馆数据库遵循PRISMA指南。符合条件的研究包括≥5例患者接受ACF-dAVFs栓塞治疗,详细说明血管造影和临床结果。我们在随机效应模型下使用95%置信区间的单比例分析,I2评估异质性,和Baujat和敏感性分析,以解决高异质性问题。通过漏斗图分析和Egger检验评估发表偏倚。结果包括栓塞后完全闭塞,血管内栓塞尝试失败,栓塞后不完全闭塞,栓塞后症状缓解或临床改善,复发;手术相关并发症,发病率,和死亡率。此外,对专门使用Onyx™栓塞系统的研究进行了亚分析。18项研究包括231项ACF-dAVF。血管内栓塞尝试失败率为2%。完全闭塞率为85%,4%的并发症。不完全闭塞率为10%。成功栓塞的患者在94%的病例中经历了症状缓解或临床改善。发病率和死亡率分别为1%和0%,分别。Onyx子分析显示,尝试失败的总比率为0%,95%为完全闭塞,不完全闭塞为5%。症状缓解或临床改善为98%,复发率为0%。ACF-dAVF的EVT是高度可行的,有效,和安全,并发症发生率低,发病率,和死亡率。与涉及所有纳入研究的主要分析结果相比,专注于Onyx栓塞的子分析显示出更好的疗效和安全性结果。
Dural Arteriovenous Fistulas (dAVFs) of the anterior cranial fossa (ACF) are uncommon but carry a high risk of hemorrhage and pose substantial treatment challenges. Recent advancements in endovascular treatment (EVT), including the introduction of novel liquid embolic agents, have markedly bolstered EVT\'s role in managing ACF-dAVFs, with notable series published in the last five years. We aimed to assess the feasibility, safety, and efficacy of EVT for ACF-dAVFs. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines. Eligible studies included those with ≥ 5 patients undergoing embolization of ACF-dAVFs, detailing both angiographic and clinical outcomes. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Publication bias was assessed by funnel-plot analysis and Egger\'s test. Outcomes included complete occlusion following embolization, unsuccessful endovascular embolization attempts, incomplete occlusion following embolization, symptom resolution or clinical improvement following embolization, recurrence; procedure-related complications, morbidity, and mortality. Additionally, a subanalysis for studies exclusively utilizing Onyx™ embolic system was done. Eighteen studies comprising 231 ACF-dAVF were included. Unsuccessful endovascular embolization attempts rate was 2%. Complete occlusion rate was 85%, with 4% of complications. Incomplete occlusion rate was 10%. Successfully embolized patients experienced either symptom resolution or clinical improvement in 94% of cases. Morbidity and mortality rates were 1% and 0%, respectively. Onyx subanalyses showed an overall rate of 0% for unsuccessful attempts, 95% for complete occlusion, and 5% for incomplete occlusion. Symptom resolution or clinical improvement was 98% and recurrence rate was 0%. EVT for ACF-dAVF is highly feasible, effective, and safe, with a low rate of complications, morbidity, and mortality. The subanalyses focusing on Onyx embolizations revealed superior efficacy and safety outcomes compared to the findings of the primary analyses involving all included studies.