Transarterial embolization in non-cavernous and cavernous sinus dural arteriovenous fistulas: A systematic review and meta-analysis of proportions.
Clin Neurol Neurosurg
; 245: 108478, 2024 Oct.
Article
en En
| MEDLINE
| ID: mdl-39116793
ABSTRACT
BACKGROUND:
Transarterial embolization (TAE) is pivotal in managing non-cavernous and cavernous sinus dural arteriovenous fistulas (CSDAVFs).METHODS:
Systematic searches were conducted across ScienceDirect, Medline, and Cochrane databases for longitudinal studies on TAE outcomes in non-CSDAVFs and CSDAVFs. Post-procedural outcomes, including complete, incomplete, and failed AVFs obliteration, and end-study outcomes were analyzed.RESULTS:
Our meta-analysis involved 27 studies with 643 patients and 736 fistulas. Symptoms in both groups included tinnitus (29.74â¯%), ocular/visual symptoms (29.12â¯%), hemorrhage (19.42â¯%), and headache (19.11â¯%). Feeding arteries mainly originated from the meningeal arteries (49.16â¯%). In non-CSDAVFs cases, fistula locations were within sinus complexes (69.23â¯%) and specific dural areas (28.31â¯%). Complete AVFs obliteration was 81â¯% (95â¯%CI 70â¯% - 90â¯%), slightly higher in non-CSDAVFs (82â¯%, 95â¯% CI 69â¯% - 92â¯%) than CSDAVFs (79â¯%, 95â¯%CI 58â¯% - 95â¯%). Incomplete obliteration occurred in 14â¯% (95â¯%CI 5â¯% - 39â¯%), with rates of 11â¯% (95â¯%CI 2â¯% - 26â¯%) in non-CSDAVFs and 19â¯% (95â¯% CI 5â¯% - 39â¯%) in CSDAVFs. Failed obliteration was rare (1â¯%, 95â¯%CI 0â¯% - 3â¯%), with similar rates in both groups. At end-study follow-up, resolution of AVFs was achieved in 97â¯% of cases (95â¯%CI 92â¯% - 100â¯%). However, complications occurred in 17â¯% of cases (95â¯%CI 10â¯% - 25â¯%), with a higher incidence in CSDAVFs (22â¯%, 95â¯%CI 9â¯% - 37â¯%) compared to non-CSDAVFs (13â¯%, 95â¯%CI 6â¯% - 23â¯%).CONCLUSIONS:
TAE with embolic agents demonstrates favorable outcomes in non-CSDAVFs and CSDAVFs, with high rates of AVFs obliteration and resolution. Complications, particularly in CSDAVFs, warrant careful consideration in treatment decisions.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Seno Cavernoso
/
Malformaciones Vasculares del Sistema Nervioso Central
/
Embolización Terapéutica
Límite:
Humans
Idioma:
En
Año:
2024
Tipo del documento:
Article