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Title: [Clinical outcomes following microsurgery and endovascular embolization in the management of spinal dural arteriovenous fistula: A meta-analysis study].
Author: Yuan CW, Wang YJ, Zhang SJ, Shen SL, Duan HZ.
Journal: Beijing Da Xue Xue Bao Yi Xue Ban; 2022 Apr 18; 54(2):304-314. PubMed ID: 35435197.
Abstract:
OBJECTIVE: To compare the clinical effect of microsurgery and endovascular embolization in the treatment of spinal dural arteriovenous fistula (SDAVF) by meta-analysis. METHODS: A systematic review was performed to retrieve all relevant literature about surgical treatment or endovascular embolization of SDAVF up to December 2019 through PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials Results, CNKI, Wanfang Data, and SinoMed. The Chinese and English key words included: "SDAVF", "spinal dural arteriovenous fistula", "spinal AVM", "spinal vascular malformation and treatment". The included studies were evaluated using the Newcastle-Ottawa scale. The early failure rate, long-term recurrence, neurological recovery, and complications were evaluated and the clinical effects of the two methods in the treatment of SDAVF were compared by using RevMan 5.3 software. And a further subgroup analysis of the therapeutic effect of endovascular embolization with different embolic agents was conducted. RESULTS: A total of 46 studies involving 1 958 cases of SDAVF were included, in which 935 cases were treated by microsurgery and 1 023 cases were treated by endovascular embolization. The funnel plot demonstrated that there was no publication bias. The results of meta-analysis showed that the incidence of early surgical failure was lower than that of endovascular embolization (OR=0.20, 95%CI: 0.13-0.30, P < 0.05), and the long-term recurrence was also lower than that of endovascular embolization (OR=0.36, 95%CI: 0.22-0.58, P < 0.05). The improvement of neurological function in the surgical patients is significantly higher than that in the patients treated with endovascular embolization (OR=2.86, 95%CI: 1.36-5.99, P < 0.05). There was no significant difference in the occurrence of complications in these two groups (OR=1.52, 95%CI: 0.88-2.64, P=0.14). In the cases of endovascular embolization, the risk of treatment failure or recurrence was higher with Onyx glue than with n-butyl 2-cyanoacrylate (NBCA), and the difference was statistically significant (OR=4.70, 95%CI: 1.55-14.28, P < 0.05). CONCLUSION: Although the treatment of dural arteriovenous fistulas by intravascular embolization has been widely used, the clinical effect of microsurgery is still better than that of endovascular embolization. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of endovascular treatment in SDAVF patients. 目的: 通过meta分析比较显微外科手术与血管内栓塞治疗硬脊膜动静脉瘘的临床疗效。方法: 计算机检索PubMed、Embase、Web of Science、Cochrane临床试验数据库、中国知网、万方数据库、中国生物医学文献数据库(Chinese BioMedical Literature Database，CBM)，检索时间从数据库建库至2019年12月，纳入采用显微外科手术和血管内栓塞治疗硬脊膜动静脉瘘的所有中英文文献。使用RevMan 5.3软件进行统计学分析，评估术后早期失败率、远期复发、神经功能恢复程度、并发症情况，比较两种治疗方式对硬脊膜动静脉瘘的临床疗效，并对血管内栓塞治疗进行亚组分析。结果: 纳入文献46篇，共1 958例硬脊膜动静脉瘘患者，其中935例采用显微外科手术治疗，1 023例采用血管内栓塞治疗，漏斗图显示未见明显发表偏倚。经meta分析结果显示，显微外科手术早期治疗失败的发生率低于血管内栓塞治疗(OR=0.20, 95%CI: 0.13~0.30, P < 0.05)，远期复发率也低于血管内栓塞治疗(OR=0.36, 95%CI: 0.22~0.58, P < 0.05)，显微外科手术治疗后患者神经功能改善情况优于血管内栓塞治疗的患者(OR=2.86, 95%CI: 1.36~5.99, P < 0.05)，两种治疗方式患者并发症的发生率差异无统计学意义(OR=1.52, 95%CI: 0.88~2.64, P＝0.14)。血管内栓塞治疗的患者中，使用Onyx胶进行栓塞比使用α-氰基丙烯酸正丁酯(n-butyl 2-cyanoacrylate，NBCA胶)有更高的治疗失败或复发风险，差异有统计学意义(OR=4.70, 95%CI: 1.55~14.28, P < 0.05)。结论: 虽然血管内栓塞治疗硬脊膜动静脉瘘的应用日趋广泛，但显微外科手术所获得的临床疗效仍明显优于血管内栓塞治疗。

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