Novel Segmentation of Placed Coils in the Treatment of Cavernous Sinus Dural Arteriovenous Fistulas Provides a Reliable Predictor of the Long-Term Outcome in Abducens Nerve Palsy
Novel Segmentation of Placed Coils in the Treatment of Cavernous Sinus Dural Arteriovenous Fistulas Provides a Reliable Predictor of the Long-Term Outcome in Abducens Nerve Palsy
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DOI：
10.1016/j.wneu.2018.01.136
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发表时间：
2018-05-01
影响因子：
2
通讯作者：
Kohmura, Eiji
中科院分区：
文献类型：
--
作者：
Kohta, Masaaki;Fujita, Atsushi;Kohmura, Eiji
目的：海绵窦（CS）硬脑膜动静脉瘘（DAVF）经静脉栓塞（TVE）后，外展神经麻痹（ANP）有时会持续存在。本研究的目的是评估弹簧圈质量与TVE后ANP长期结局之间的相关性。方法：2008年1月至2016年7月，33例CS DAVF患者在我院接受WE。根据与颈内动脉（伊卡）的关系，我们将CS外侧部分为以下3个部分：前外侧，伊卡前弯曲的前外侧;中外侧（ML），伊卡水平段的外侧;后外侧，伊卡后弯曲的后外侧。ANP组的弹簧圈数量（35.3 vs. 21.9弹簧圈; P = 0.04）、弹簧圈体积（198.4 vs. 103.6 mm（3）; P = 0.03）和ML中的弹簧圈体积（54.9 vs. 20.3 mm（3）; P = 0.01）显著大于非ANP组。在逻辑回归分析中，只有ML线圈体积与ANP的持续性显着相关（P = 0.04）。根据受试者工作特征曲线，ML线圈体积的最佳截止值为27.9 mm（3）（灵敏度，100%;特异性，72.4%）。ML线圈体积的截止值可以为TVE在CS DAVF中的实际应用提供良好的指导。
OBJECTIVE: Abducens nerve palsy (ANP) after transvenous embolization (TVE) for cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) sometimes persists. The aim of this study was to assess the correlation between the coil mass and the long-term outcome of ANP after TVE.METHODS: Between January 2008 and July 2016, 33 patients with a CS DAVF underwent WE at our institute. On the basis of the relationship to the internal carotid artery (ICA), we divided the lateral part of the CS into the following 3 portions: anterolateral, anterolateral to the anterior bend of the ICA; middle-lateral (ML), lateral to the horizontal segment of the ICA; and posterolateral, posterolateral to the posterior bend of the ICA.RESULTS: ANP persisted in 4 patients. The number of coils (35.3 vs. 21.9 coils; P = 0.04), coil volume (198.4 vs. 103.6 mm(3) ; P = 0.03), and coil volume in the ML (54.9 vs. 20.3 mm(3) ; P = 0.01) were significantly greater in the ANP group than in the non-ANP group. In the logistic regression analysis, only the ML coil volume was significantly associated with the persistence of ANP (P = 0.04). Based on the receiver operating characteristic curve, the optimal cutoff value of the ML coil volume was 27.9 mm(3) (sensitivity, 100%; specificity, 72.4%).CONCLUSIONS: Overpacking in the ML of the CS should be avoided to prevent persistent ANP. The cutoff value of the ML coil volume may provide a good guide for the practical use of TVE for CS DAVFs.