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Angioarchitectural features of arteriovenous fistulas at craniocervical junction predicting clinical presentation and unfavorable neurological function: insight from a multicenter cohort and pooled analysis

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Abstract

Arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) are uncommon conditions with complex angioarchitecture. The objective of this study was to identify the angioarchitectural features of CCJ-AVF that were predictive of clinical presentation and neurological function. The study encompassed a total of 68 consecutive patients with CCJ-AVF at two neurosurgical centers between 2014 and 2022. Additionally, a systematic review was conducted, including 68 cases with detailed clinical data obtained via PubMed database spanning 1990 to 2022. Clinical and imaging data were collected and pooled together to analyze factors associated with subarachnoid hemorrhage (SAH), myelopathy, and modified Rankin scale (mRS) at presentation. The mean age of the patients was 54.5 ± 13.1 years, with 76.5% of them being male. The most common feeding arteries were V3-medial branches (33.1%), and drainage was frequently through the anterior or posterior spinal vein/perimedullary vein (72.8%). SAH was the most common presentation (49.3%), and an associated aneurysm was identified as a risk factor for SAH (adjusted OR, 7.44; 95%CI, 2.89–19.15). Anterior or posterior spinal vein/perimedullary vein (adjusted OR, 2.78; 95%CI, 1.00–7.72) and male gender (adjusted OR, 3.76; 95%CI, 1.23–11.53) were associated with higher risk for myelopathy. Myelopathy at presentation was an independent risk factor for unfavorable neurological status (adjusted OR per score, 4.73; 95%CI, 1.31–17.12) in untreated CCJ-AVF. The present study identifies risk factors associated with SAH, myelopathy, and unfavorable neurological status at presentation in patients with CCJ-AVF. These findings may help treatment decisions for these complex vascular malformations.

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Availability of data and materials

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Funding

This work was supported by the Outstanding Academic Leaders Program of Shanghai Municipal Commission of Health and Family Planning (No. 2017BR006 to WZ), National Natural Science Foundation of China (No. 81571102, No. 81870911 to WZ), Clinical Research Plan of SHDC (No. SHDC2020CR2034B to WZ, No. SHDC2020CR4033 to KQ), Shanghai Municipal Science and Technology Major Project (No. 2018SHZDZX01), and CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5-008).

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Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China

    Zongze Li, Hongfei Zhang, Peixi Liu, Yuan Shi, Mingjian Liu, Kai Quan, Yanlong Tian, Peiliang Li & Wei Zhu

  2. National Center for Neurological Disorders, Shanghai, 200040, China

    Zongze Li, Hongfei Zhang, Peixi Liu, Yuan Shi, Mingjian Liu, Kai Quan, Yanlong Tian, Peiliang Li & Wei Zhu

  3. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China

    Zongze Li, Hongfei Zhang, Peixi Liu, Yuan Shi, Mingjian Liu, Kai Quan, Yanlong Tian, Peiliang Li & Wei Zhu

  4. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Zongze Li, Hongfei Zhang, Yang Zhao, Peixi Liu, Yuan Shi, Mingjian Liu, Kai Quan, Yanlong Tian, Peiliang Li & Wei Zhu

  5. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Zongze Li, Hongfei Zhang, Yang Zhao, Peixi Liu, Yuan Shi, Mingjian Liu, Kai Quan, Yanlong Tian, Peiliang Li & Wei Zhu

  6. Department of Neurosurgery, Peking University International Hospital, Beijing, 102206, China

    Yuanli Zhao

  7. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100079, China

    Yuanli Zhao

  8. China National Clinical Research Center for Neurological Diseases, Beijing, 100079, China

    Yuanli Zhao

  9. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100079, China

    Yuanli Zhao

  10. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, 100079, China

    Yuanli Zhao

Authors
  1. Zongze Li
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  2. Hongfei Zhang
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  3. Yang Zhao
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  5. Yuan Shi
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  6. Mingjian Liu
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  8. Yanlong Tian
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  9. Peiliang Li
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  10. Yuanli Zhao
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  11. Wei Zhu
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Contributions

Conception and design: Z Li, Zhang. Acquisition of data: Y Zhao, P Liu.

Analysis and interpretation of data: M Liu, Shi.

Drafting the article: Z Li.

Reviewed submitted version of manuscript: Y Liu, P Liu, Shi.

Approved the final version of the manuscript on behalf of all authors: Zhu.

Statistical analysis: Zhang.

Administrative/technical/material support: P Li, Tian.

Study supervision: Zhu , YL Zhao.

All authors reviewed the manuscript.

Corresponding author

Correspondence to Wei Zhu.

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Ethics approval

This is an observational study. The Huashan Hospital Research Ethics Committee has confirmed that no ethical approval is required.

Consent to participate

The informed consent was waived for this retrospective study.

Competing interests

The authors declare competing interests.

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Zongze Li and Hongfei Zhang contributed to this work equally.

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Li, Z., Zhang, H., Zhao, Y. et al. Angioarchitectural features of arteriovenous fistulas at craniocervical junction predicting clinical presentation and unfavorable neurological function: insight from a multicenter cohort and pooled analysis. Neurosurg Rev 46, 153 (2023). https://doi.org/10.1007/s10143-023-02057-6

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