| Part Ⅰ Clinical outcomes of low-and intermediate-grade lateral sinuses dural arteriovenous fistulas with the strategy of involving sinuses occlusionObjective:To clarify the effect of contralateral venous sinus conditions on clinical outcomes in patients with low-and intermediate-grade transverse and sigmoid sinuses dural arteriovenous fistulas and involving sinuses occlusion after endovascular therapy.Methods:Fifty-five patients treated in our center with low-and intermediate-grade transverse and sigmoid sinuses dural arteriovenous fistulas and involving sinuses occlusion after operation were analyzed retrospectively from September 1999 to April 2020.According to the patency score of contralateral venous sinus,the patients were divided into the contralateral venous sinus stenosis group and the patency group.The single factor analysis was used to analysis the clinical data and imaging data of the two groups.Results:1)A total of 55 TSSDAVF patients with low and medium grades were included,including 40 males and 15 females,with an average age of 50.3 years.The preoperative mRS score of contralateral venous sinus patency group with 34 patients and stenosis group with 21 patients had no significant difference(P>0.05)2)Thirty-eight patients(69.1%)received DSA follow-up of more than 3 months,including 1 de novo fistula in the contralateral venous sinus patency group,10 recurrent fistulas and 3 de novo fistulas in the stenosis group.The DSA follow-up result of more than 3 months showed that the rate of occurrence and de novo fistula in patency group was significantly lower than that in stenosis group(P=0.0001).3)Fifty-three(96.4%)patients were received followed up recently for an average of 57 months.Compared with the preoperative clinical results,patients with 3-6 mRS points were reduced by 62.5%,patients with 3-6 mRS points were reduced by 80.0%in the patency group and 33.3%in the stenosis group,and the patency group was significantly better than the stenosis group.Conclusion:For patients with low-and intermediate-grade TSSDAVF and involved venous sinuses occlusion,the rate of occurrence and de novo fistula with contralateral sinus patency was lower than that with contralateral sinus stenosis.According to the reduction rate of 3-6 mRS points,the clinical recovery after operation with contralateral sinus patency was better than that with contralateral venous sinus dysplasia,stenosis or occlusion.Part Ⅱ Clinical outcomes of low-and intermediate-grade lateral sinuses dural arteriovenous fistulas with patency of lateral sinusObjective:To clarify the effect of bilateral venous sinus patency on clinical outcomes in patients with low-and intermediate-grade transverse and sigmoid sinuses dural arteriovenous fistulas after endovascular therapy.Methods:Seventy-seven patients treated in our center with low-and intermediate-grade transverse and sigmoid sinuses dural arteriovenous fistulas after operation were analyzed retrospectively from September 1999 to April 2020.According to the patency score of bilateral lateral sinus,0-4 score was defined as restricted group and 5-8 score was defined as patency group.The single factor analysis was used to analysis the clinical data and imaging data of the two groups.Results:1)A total of 77 TSSDAVF patients with low and medium grades were included,including 47 males and 30 females,with an average age of 51.3 years.Immediate postoperative fistula complete embolization rate of restricted group is 78.7%and patency group is 68.8%(P>0.05).The preoperative and recent mRS score of patency group with 34 patients and restricted group with 21 patients had significant difference(P<0.05).2)Fifty-five patients(71.4%)received DSA follow-up of more than 3 months,including 35 complete obliterations(63.6%),6 stable fistulas(10.9%),10 recurrent fistulas(18.2%)and 4 de novo fistulas(7.3%).No recurrent fistula was found in the patency group,and 10 recurrent fistulas and 3 de novo fistulas were found in the restricted group.The DSA follow-up result of more than 3 months showed that the rate of occurrence and de novo fistula in patency group was significantly lower than that in restricted group(P<0.05).Conclusion:Low-and intermediate-grade TSDAVFs could obtained imaging obliteration completely in our center.High complete obliteration rate could be achieved in the medium and long term follow-up.However,there is the possibility of recurrence or de novo fistula.When the patency degree of the sinus is high after operation,the rate of recurrence or de novo fistula is low.Part Ⅲ Clinical outcomes of low-and intermediate-grade transverse and sigmoid sinuses dural arteriovenous fistulas with the strategy of venous sinus protectionObjective:To analyze the clinical and imaging results of patients treated with a variety of venous sinus protection strategies in single center study,and analyze the factors influencing the interim results.Methods:Fifty-two patients with low-and intermediate-grade transverse and sigmoid sinuses dural arteriovenous fistulas after operation were treated with the strategy of venous sinus protection and analyzed retrospectively from September 1999 to April 2020.Transarterial approach were performed in 28 cases,transvenous approach with embolization of anterior sinus vein was performed in 5 cases and transvenous with intra-sinus balloon protection was performed in 19 cases.Descriptive analysis was performed on the treatment and clinical prognosis of each group.Results:1)A total of 52 TSSDAVF patients with low and intermediate grades were included,including 28 males and 24 females,with an average age of 51 years.Transarterial approach were performed in 20 cases(71.4%,20/28),transvenous approach with embolization of anterior sinus vein was performed in 4 cases(80.0%,4/5)and transvenous with intra-sinus balloon protection was performed in 13 cases(68.4%,13/19).2)The drainage function of the affected side of the venous sinus was preserved in 27 cases,including 12 cases(42.9%,12/28)treated with transarterial approach,4 cases(80.0%,4/5)treated with embolization of anterior sinus vein via venous approach(80.0%,4/5),and 11 cases(57.9%,11/19)treated with intra-sinus balloon protection(57.9%).Twenty-five patients with preoperative stenosis of involving sinus suffered sinus occlusion after operation.Patients with preoperative venous sinus stenosis are more likely to have postoperative venous sinus occlusion(P<0.05)3)The overall complication rate was 9.6%(5/52),including 2 cases(3.8%)with permanent neurological impairment.4)Follow-up results of 50 patients(96.2%)were received recently,compared with the preoperative mRS score,and 3-6 mRS points decreased by 75.0%.5)40 cases(76.9%)patients received the DSA follow-up of more than 3 months,including 27(67.5%)complete obliterations,1(2.5%)improvement,3(7.5%)stability,7(17.5%)recurrence and 2 cases(5.0%)de novo fistulas.There were 4 recurrence or de novo fistulas(23.5%,4/17)in the treatment group of transarterial approach,1(25.0%,1/4)in the treatment group of anterior sinus vein embolization via venous approach,and 4(21.1%,4/19)in the treatment group of intra-sinus balloon protection.The involved sinus of all patients with recurrence or de novo fistula were occluded after operation,that is,postoperative occlusion of the involving sinus was more likely to have recurrence or de novo DAVF(P<0.05).The incidences of occuring recurrence or de novo fistula in different treatment groups don’t have significant difference(P>0.05).Conclusion:1)The low-and intermediate-grade TSSDAVF treated by the venous sinus protection strategy in our center could obtained imaging obliteration completely,and the rate of complete obliteration was high in the medium and long-term follow-up period2)The treatment of TSSDAVF with low and intermediate grade TSSDAVF by intra-sinus balloon protection could preserve the function of venous sinus drainage,ensuring a high rate of complete obliteration during medium and long-term follow-up,improving the mRS score with a low probability of postoperative complications.3)Preoperative stenosis of involving sinus is more likely to occur on occlusion after operation.4)For TSSDAVF of low and middle grade with occlusion of involving sinus after operation,it is easy to occur recurrence or de novo fistula.The incidences of occuring recurrence or de novo fistula in different treatment groups don’t have significant difference. |
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