การวิเคราะห์ลักษณะโรคของผู้ป่วยในเขตภาคเหนือตอนบนด้วย ภาวการณ์เชื่อมต่อผิดปกติของหลอดเลือดแดงและดำที่ระดับเยื่อหุ้มสมอง การศึกษาเบื้องต้น

Abstract

Objective: To analyse natural history, angioarchitecture, management and treatment outcomes of intracranial dural arteriovenous fistula in our institute. Methods and Materials: A retrospectively reviewed 61 patients with intracranial dural arteriovenous fistulas (DAVF) presented at our institute between June 2010 and October 2014. The clinical presentations, presumable causes, imaging findings and treatment outcome were reviewed. Results: The mean age of the study population was 50.4 years with a female predominant. The majority of cases (77%) presented with benign symptoms. DAVF at the sigmoid sinus and anterior cranial fossa were found to present with malignant clinical presentation (P<0.05). A benign clinical manifestation was found with statistical significant (P<0.001) in the location of the cavernous sinus. Cortical venous reflux (CVR) was found in all cases presented with aggressive manifestation (P<0.001) and no CVR was present when there was no venous outflow restriction (P<0.001). Conservative management and symptomatic treatment in patients with tolerable benign symptoms and absence of CVR showed an improved clinical outcome in about 82%. All of the patients underwent embolization had improved clinical outcome. Conclusion: DAVF commonly occurs in middle to late adulthood with a variable clinical manifestations mostly associated to the shunt location. Shunt location, CVR and venous outflow restriction were shown to be related with aggressive manifestation. Endovascular embolization was the mainstay therapeutic method with high rate of good outcomes. In the absence of CVR and tolerable benign symptoms, conservative management with symptomatic treatment could be done. Keywords: dura mater, arteriovenous fistula, clinical manifestation, therapeutic embolization