BackgroundIntracranial dural arteriovenous fistulas (dAVFs) are abnormal connections between arteries and veins within the dura mater. Various treatment modalities, such as surgical ligation, endovascular intervention, and radiosurgery, aim to close the fistulous connection. Although transvenous embolization (TVE) is the preferred method for carotid-cavernous fistulas, its description and outcomes for noncavernous dAVFs vary. This has prompted a systematic review and meta-analysis to comprehensively assess the effectiveness of TVE in treating noncavernous dAVFs, addressing variations in outcomes and techniques.MethodsWe searched PubMed and Embase, spanning from the earliest records to December 2022, to identify pertinent English-language articles detailing the utilization of TVE. We focused on specific procedural details, outcomes, and complications in patients older than 18 years. The data collected and analyzed comprised the sample size, number of fistulas, publication specifics, presenting symptoms, fistula grades, and pooled rates of embolizations, outcomes, follow-up information, and complications.ResultsFrom a total of 565 screened articles, 15 retrospective articles encompassing 166 patients spanning across seven countries met the inclusion criteria. Their Newcastle–Ottawa scores ranged from 6 to 8. Intraprocedural complication rate was 10% (95% confidence interval [CI] = 5.9–17.1) and in-hospital postprocedural complication rate was 5.4% (95% CI = 2.8–10.6). Prevalence of in-hospital mortality was 5.5% (95% CI = 2.9–10.6). Complication rate during follow-up was 8.6% (95% CI = 4.7–15.7) with fistula rupture occurring in 5.5% (95% CI = 2.6–11.6) of patients. Complete obliteration rate at final angiographic follow-up was 94.9% (95% CI = 90.3–99.9). Symptoms improved in 95% (95% CI = 89.8–100) of patients at final follow-up.ConclusionTo our knowledge, we present the first meta-analysis assessing obliteration rates, outcomes, and complications of TVE for dAVFs. Our analysis highlights the higher (>90%) complete obliteration rates. Large prospective multicenter studies are needed to better define the utility of TVE for noncavernous dAVFs.

中文翻译：

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非海绵状硬脑膜动静脉瘘（dAVF）的经静脉栓塞：系统评价和荟萃分析

背景颅内硬脑膜动静脉瘘（dAVF）是硬脑膜内动脉和静脉之间的异常连接。各种治疗方式，例如手术结扎、血管内介入和放射外科，旨在闭合瘘管连接。尽管经静脉栓塞 (TVE) 是颈动脉海绵窦瘘的首选方法，但其对非海绵状 dAVF 的描述和结果各不相同。这促使我们进行系统回顾和荟萃分析，以全面评估 TVE 治疗非海绵状 dAVF 的有效性，解决结果和技术的差异。方法我们检索了 PubMed 和 Embase，从最早的记录到 2022 年 12 月，以确定相关的英语语言详细介绍 TVE 的利用的文章。我们重点关注 18 岁以上患者的具体手术细节、结果和并发症。收集和分析的数据包括样本量、瘘管数量、发表细节、表现症状、瘘管分级以及栓塞汇总率、结果、随访信息和并发症。结果来自总共 565 篇筛选文章，其中 15 篇回顾性文章涵盖七个国家的 166 名患者符合纳入标准。他们的纽卡斯尔-渥太华评分范围为 6 至 8。术中并发症率为 10%（95% 置信区间 [CI] = 5.9-17.1），院内术后并发症率为 5.4%（95% CI = 2.8-10.6）。院内死亡率为 5.5%（95% CI = 2.9–10.6）。随访期间的并发症率为 8.6% (95% CI = 4.7–15.7)，其中 5.5% (95% CI = 2.6–11.6) 的患者发生瘘管破裂。最终血管造影随访时的完全闭塞率为 94.9% (95% CI = 90.3–99.9)。最终随访时，95% (95% CI = 89.8–100) 的患者症状得到改善。结论据我们所知，我们提出了第一个荟萃分析，评估 dAVF 的闭塞率、结局和 TVE 并发症。我们的分析强调了更高的完全消失率 (>90%)。需要进行大型前瞻性多中心研究来更好地确定 TVE 对非海绵状 dAVF 的效用。