頭蓋硬膜動静脈瘻の術後神経学的転帰予測における動脈供給の役割：単一施設の後ろ向き研究

Dural arteriovenous fistulas (dAVFs) are rare vascular malformations characterized by direct shunting between dural arteries and venous sinuses or cortical veins. A comprehensive framework does not exist when deciding upon intervention for dAVFs. This study investigates the influence of arterial feeders in predicting treatment modality and neurological morbidity following intervention for dAVFs.

A retrospective cohort study was conducted of consecutive patients treated for intracranial dAVFs at a tertiary neurosurgical center in Victoria, Australia, between June 2016-June 2024. The primary outcome was functional morbidity at discharge (modified Rankin Scale ≥ 3). Secondary outcomes included the relationship between arterial feeders, treatment modality and obliteration rates.

Fifty-two patients with 60 dAVFs were included. CVR was present in 93 % of lesions, and 22 % were ruptured at presentation. The middle meningeal artery was the most frequent feeder (68.3 %). Endovascular therapy was the initial treatment for 31 lesions (52 %), achieving an overall obliteration rate of 92 % and a complication rate of 21 %. Endovascular intervention was more common when the occipital (68 % vs 34 %, p = 0.01) or posterior meningeal (32 % vs 6.9 %, p = 0.011) arteries supplied the lesion, whereas surgical treatment predominated with superficial temporal (34 % vs 13 %, p = 0.048) or ophthalmic (28 % vs 3.2 %, p = 0.011) feeders. Functional morbidity at discharge was higher among lesions with posterior circulation supply (78 % vs 29 %, p = 0.009) and lower in those with external carotid artery (44 % vs 88 %, p value = 0.007). Posterior feeders were particularly associated with morbidity following surgery (80 % vs 17 %, p = 0.013).

Arterial supply may influence both treatment selection and neurological outcomes in dAVFs. Posterior circulation feeders were associated with greater morbidity, whereas lower morbidity rates were seen in lesions with external carotid supply. Recognition of these arterial factors may aid in tailoring intervention strategies and, when combined with known venous prognostic factors, may inform counselling regarding procedural risk.