Clinical Study Of Curative Embolization For The Treatment Of Cerebral Dural Arteriovenous Fistulas

Objective:To discuss the relevant predicative factors of dural arteriovenous fistulas (DAVF) in intracranial hemorrhage. Compare the efficacy of different embolic materials in thrombotherapy of DAVF, and discuss the surgical techniques in curative embolization for the treatment of DAVF. Accumulate clinical experience and improve treatment level and efficacy of the dural arteriovenous fistulas.Methods:To review and sum up the First Affiliated Hospital of Kunming Medical University Imaging Department in January2012to April201421DAVF patients which were treated. The patients were divided into:intracranial hemorrhage group and not bleeding group. The differences between the two groups were analyzed and logistic regression analysis was performed concerning the clinical features and angioarchitecture. There are15patients underwent endovascular treatment, arterial approach endovascular embolization, embolization material is Onyx (moder Onyx-18) and Professional Video Assistant; by vein embolization approach is:through the femoral vein to internal jugular vein to the inferior petrosal sinus to cavernous sinus; embolic material:GDC+Onyx. Angiography immediately after embolization all patients understand the situation of the fistula closed, up for2months to2years.Results:Conducted on21patients’clinical data and imaging analysis.(1) general information:The age was from31-76years, mean50.00+10.5years; male14cases, accounting for66.67%,7females, accounting for33.33%.(2) Clinical manifestation: intracranial hemorrhage in14cases, not bleeding in7cases.Intracranial hemorrhage were14cases,12cases of male patients, accounting for85.71%;2cases of female patients accounting for14.29%.Sex has significant.(3) Angioarchitecture features:①Fistulas’location:the group of female patients, cavernous sinus fistula in4cases, lateral sinus (transverse sinus-sigmoid sinus) in1case,1case of sink sinus, superior sagittal sinus in1case; the group of male Patients, cavernous sinus fistula in0case, side sinus (transverse sinus-sigmoid sinus) in3cases,5cases of superior sagittal sinus, sinus sink in2cases, sky sigmoid sinus area in4cases. Fistulas’location has significant. Hemorrhage group has large venous sinus area14cases but no cavernous sinus region, Fistulas’ location has significant.(P=0.017).②The feeding arteries: external carotid artery(ECA) system53, internal carotid artery(ICA) system9, and vertebral-basilar artery system13.③Dorden type:Borden I has5cases, BordenⅡhas3cases, Borden Ⅲ has13cases. Hemorrhage group Borden Ⅰ+Ⅱ type in3cases, Borden Ⅲ type11cases. Borden type has the significant (P=0.041).(8) The univariate analysis of the three statistically significant:male, large venous sinus, BordenⅢ carried Logistic analysis of male (P=0.009), large venous sinus (P=0.002), Borden Ⅲ(P=0.034), the3factors are risk factors of intracranial hemorrhage in DAVF.Treatment:(1) The group of21patients,15patients underwent endovascular treatment, Onyx alone arterial approach endovascular embolization10cases, GDC+Onyx by vein embolization approach2case, preoperative embolization with PVA combined surgery2cases, PVA embolization after trans-catheter arterial embolization Onyx recurrence in1case.(2)Arterial approach using Onyx embolization with Onyx rubber in10cases, including one-time total occlusion of the fistula in9cases of fistula blood flow was significantly reduced at1case, the interval February2nd underwent embolization, complete fistula occlusion;2case by vein embolization approach is:through the femoral vein to internal jugular vein to the superior petrosal sinus to cavernous sinus; embolic material:GDC+Onyx. Partial and complete fistula thrombosis embolism in1case (3) In this group of patients, there were no complications and deaths.(4) In the2months to2years of follow-up, GOS score5points in12cases,4points in1case,3points in1case, lost1.Conclusion:(1)Intracranial hemorrhage is the common clinical manifestations of DAVF; In male patients the rate of large sinus fistulas were the highest; intracranial hemorrhage rate is high; female patients the rate of cavernous sinus fistulas were high, intracranial hemorrhage rate is low.(2)In feeding arteries,the arteries of ECA system were the most, the middle meningeal artery and occipital artery were the most.(3)Borden type is simple and effective. It is the relevant predicative factors of intracranial hemorrhage; Borden Ⅲ has high intracranial hemorrhage rate.(4)Onyx-18is safe and effective.It is curative embolic material for DAVF.(5)Onyx-18arterial approach for the treatment of DAVF, the site of ideal embolic occlusion is fistula and the proximal of venous drainage.(6) When treated DAVF with Onyx-18in artery, we prefer to choose external carotid artery.(7) For the DAVF of multi-feeding arteries cavernous sinus trans-venous embolization or occlusion of the venous sinus fistula can achieve curative embolization.