Drenagem venosa cerebral em pacientes portadores de fístula arteriovenosa dural - correlação com a apresentação clínica
Dural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets. Symptoms may be mild or severe and are related to the patient’s venous anatomy. Our hypothesis is that the patient’s venous anatomy determines development of symptoms. The aim is to id...
Na minha lista:
| Autor principal: | |
|---|---|
| Outros Autores: | |
| Formato: | doctoralThesis |
| Idioma: | pt_BR |
| Publicado em: |
Universidade Federal do Rio Grande do Norte
|
| Assuntos: | |
| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/30412 |
| Tags: |
Adicionar Tag
Sem tags, seja o primeiro a adicionar uma tag!
|
| Resumo: | Dural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous
connections within the dural leaflets. Symptoms may be mild or severe and are
related to the patient’s venous anatomy. Our hypothesis is that the patient’s venous
anatomy determines development of symptoms. The aim is to identify which venous
anatomy elements are important in the development of major symptoms in patients
with a DAVF. With this purpose a multicenter study based on the retrospective
analysis of cerebral angiographies with systematic assessment of brain drainage
pathways (including fistula drainage) in patients over 18 years of age with single
DAVF. The patients were divided into two groups, with minor (group 1, n=112) and
with major symptoms (group 2, n=89). Group 2 was subdivided into 2a –
hemorrhage (n=47) and 2b- severe non-hemorrhagic symptoms (n=42). The prevalence of stenosis in DAVF venous drainage and identification of
tiny anastomoses between venous territories was significantly higher in group 2
(32.6% and 19.1%, respectively) when compared to group 1 (2.68% and 5.36%,
respectively). Stenosis of DAVF venous drainage was significantly more frequent in
group 2a than in group 2b (51.1% vs. 11.9%, p<0.001). Group 2b patients had
increased prevalence of shared use of the cerebral main drainage pathway (85.0%
vs. 53.2%, p=0.002), absence of an alternative route (45.0% vs. 17.0%, p=0.004)
and presence of contrast stagnation (62.5% vs. 29.8%, p=0.002) when compared to
group 2a. In patients with high-grade fistula the group with major symptoms had
increased prevalence of a single draining direction (31.3% vs. 8.33%, p=0.003),
stenosis in the draining vein (35.0% vs. 6.25%, p=0.000), absence of an alternative
pathway for brain drainage (31.3% vs. 12.5%, p=0.017) and presence of contrast
stagnation (48.8% vs. 22.9%, p=0.004). Major symptoms were observed when normal brain tissue venous drainage
was impaired by competition with DAVF (predominance in group 2b) or when DAVF
venous drainage had anatomical characteristics that hindered drainage, with
consequent venous hypertension on the venous side of the DAVF (predominance in
group 2a). The same findings were observed when comparing two groups of
patients with high-grade lesions, those with major versus those with minor
symptoms. |
|---|