Hybrid treatment of central nervous system arteriovenous fistulas: A single center experience

Öz

Aim: Central nervous system arteriovenous fistulas (AVFs) are abnormal connections between arteries and veins that pose a significant neurological risk. This study evaluated the clinical and angiographic outcomes of patients who underwent endovascular (EVT), surgical (ST), or hybrid (surgery after endovascular treatment) treatment for cerebral AVFs. Material and Methods: A retrospective analysis was conducted on 22 patients treated at our hospital between January 2023 and January 2024. The collected data included demographics, Glasgow Coma Scale score, feeding artery, fistula classification, treatment modality, angiographic and neurological outcomes, and mortality. Treatment decisions were individualized based on fistula characteristics and patient condition. Statistical analyses were performed using SPSS v25.0. Results: Twenty-two patients (mean age 52.4, 68.2% male) underwent EVT (n=12), ST (n=5), or hybrid (n=5) treatment. Complete fistula occlusion was achieved in 11 patients (50%), with no significant difference among treatment groups (EVT 36.4%, ST 36.4%, hybrid 27.3%, p=0.29). Overall mortality was 18.2% (EVT 3 (25%), ST 1 (2%), p=0.77). Neurological outcomes showed that 31.8% developed new postoperative deficits, 31.8% had unchanged neurological deficits and 36.4% experienced complete neurological recovery. Notably, no neurological deterioration was observed in the hybrid treatment group. Patients who received hybrid treatment exhibited a significantly higher complete recovery rate (p=0.004). Hybrid treatment may be associated with less neurological deterioration and greater improvement. Conclusion: Endovascular, surgical, and hybrid approaches showed comparable effectiveness in treating AVFs in terms of occlusion rates, neurological deficits, and mortality. In addition, hybrid treatment has significant advantages, including a high complete recovery rate and low neurological deterioration rate. Larger multicenter prospective studies are warranted to further refine the treatment protocols.

Anahtar Kelimeler

• Arteriovenous fistula
• central nervous system
• hybrid treatment
• endovascular surgery
• microsurgery

Santral sinir sistemi arteriyovenöz fistüllerinin hibrit tedavisi: Tek merkez deneyimi

Öz

Amaç: Santral sinir sistemi (SSS) arteriovenöz fistülleri (AVF); önemli nörolojik riskleri olan, arterler ve venler arasındaki patolojik bağlantılardır. Bu çalışmada, SSS AVF’lerinin tedavisinde uygulanan endovasküler, cerrahi ve hibrit (kombine) yöntemlerin klinik ve anjiyografik sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Ocak 2023 ile Ocak 2024 tarihleri arasında hastanemizde AVF nedeniyle tedavi gören 22 hastanın retrospektif analizi yapılmıştır. Toplanan veriler; demografik özellikleri, Glasgow Koma Skala skoruna, besleyici arterleri, fistül sınıflandırmasını, tedavi yöntemini, mortaliteyi, anjiyografik ve nörolojik sonuçları içermektedir. Tedavi kararları, fistül özelliklerine ve hasta durumuna göre bireyselleştirilmiştir. İstatistiksel analizler SPSS v25.0 kullanılarak yapılmıştır. Bulgular: Yirmi iki hastaya (ortalama yaş 52,4, %68,2 erkek) endovasküler (n=12), cerrahi (n=5) veya hibrit (n=5) tedavi uygulanmıştır. Tam fistül oklüzyonu 11 hastada (%50) sağlanmış ve tedavi grupları arasında anlamlı bir fark izlenmemiştir (endovasküler %36,4, cerrahi %36,4, hibrit %27,3, p=0,29). Genel mortalite %18,2 olarak hesaplanmıştır (endovasküler 3 (%25), cerrahi 1 (%20), p=0,77). Nörolojik sonuçlar, hastaların %31,8'inde yeni postoperatif defisitlerin geliştiğini, %31,8'inde nörolojik defisitlerin değişmediğini ve %36,4'ünde tam nörolojik iyileşme olduğunu göstermiştir. Hibrit tedavi grubunda nörolojik kötüleşme saptanmamıştır (p=0,11). Hibrit tedavi grubundaki hastalarda tam iyileşme oranının belirgin şekilde yüksek olduğu görülmüştür (p=0,004). Hibrit tedavi daha az nörolojik gerileme ve daha fazla nörolojik iyileşme ile ilişkili olabilir. Sonuç: AVF tedavisinde uygulanan endovasküler, cerrahi ve hibrit yaklaşımlar; oklüzyon oranları, nörolojik defisitler ve mortalite açısından karşılaştırılabilir etkinlik göstermiştir. Bunun yanı sıra; yüksek tam iyileşme ve daha az nörolojik kötüleşme oranıyla, hibrit tedavinin önemli avantajları olduğu söylenebilir. Tedavi protokollerini geliştirmek için çok merkezin dahil olduğu, büyük ölçekli, prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Arteryovenöz fistüller
• santral sinir sistemi
• hibrit tedavi
• endovasküler tedavi
• mikrocerrahi

Kaynakça

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