Introduction
Material and Methods
Study Design
Study Selection
Institutional Series
Outcomes Measurement
Statistical Analysis
Results
Study Selection and Characteristics
First author | Publication year | Country | Study design | Total sample | % Males | Mean age, years (SD) | N. fistulas | N. procedures |
---|---|---|---|---|---|---|---|---|
Klisch | 2003 | Germany | Retrospective | 11 | 18.2 | 62.5 (15.5) | 14 | 11 |
Luo | 2009 | China | Retrospective | 11 | 72.7 | 31.0 (NR) | 11 | 11 |
Lv | 2008 | China | Retrospective | 17 | 47.1 | 47.6 (NR) | 20 | 22 |
Miller | 1995 | USA | Retrospective | 10 | 40.0 | 51.9 (14.8) | 11 | 10 |
Nishimuta | 2017 | Japan | Retrospective | 50 | 16.0 | 66.2 (11.3) | 59 | 50 |
Pashapour | 2014 | Iran | Prospective | 46 | 63.0 | 36.8 (NR) | 47 | 46 |
Satow | 2013 | Japan | Retrospective | 20 | 25.0 | 67.5 (NR) | 21 | 22 |
Yoshida | 2009 | Japan | Retrospective | 44 | 29.5 | 66.0 (NR) | 51 | 49 |
Zhang | 2010 | China | Retrospective | 22 | 72.7 | 49.0 (NR) | 22 | 27 |
Lee | 2019 | Korea | Retrospective | 121 | 33.1 | 58.0 (11.9) | 134 | 153 |
Rhim | 2015 | Korea | Retrospective | 49 | 30.6 | 57.2 (NR) | 49 | 49 |
Yu | 2007 | China | Retrospective | 98 | 25.5 | 57.66 (17.2) | 98 | 74 |
Alexander | 2019 | USA | Retro- and prospective | 267 | 21.7 | 60.9 (NR) | 267 | 267 |
Ertl | 2020 | Germany | Retrospective | 33 | 30.3 | 65.5 (13.7) | 33 | 33 |
Cha | 2012 | Korea | Retrospective | 14 | 28.6 | 60.6 (9.4) | 14 | 11 |
Cheng | 2003 | China | Retrospective | 27 | 11.1 | 60.3 (12.9) | 27 | 29 |
De castro-Afonso | 2017 | Brazil | Retrospective | 62 | 38.7 | 62.7 (12.5) | 62 | 63 |
Jiang | 2008 | China | Retrospective | 12 | 25.0 | 54.5 (14.9) | 12 | 12 |
Jia | 2018 | Korea | Retrospective | 52 | 23.1 | 59.1 (10.7) | 52 | 53 |
Holland | 2018 | Australia | Retrospective | 23 | 21.7 | 64.0 (NR) | 23 | 13 |
Griauzde | 2016 | USA | Retrospective | 37 | 29.7 | 64.0 (NR) | 37 | 32 |
Alexandre | 2021 | Italy | Retrospective | 17 | 47.1 | 66.0 (11.7) | 17 | 21 |
Outcomes (22 studies included) | Patients (n/N) | Raw proportions (95% CI) | Pooled proportions (95% CI) | I2 (%) |
---|---|---|---|---|
1. Barrow classification: | ||||
Type A | 0/1043 | – | – | – |
Type B | 110/1043 | 10.5 (8.74–12.6) | 5.70 (1.51–11.7) | 89 |
Type C | 85/1043 | 8.15 (6.56–10.0) | 7.79 (2.63–14.8) | 90 |
Type D | 434/1043 | 41.6 (38.6–44.7) | 31.9 (12.5–55.0) | 98 |
2. Cognard classification: | ||||
Type I | 45/1043 | 4.31 (3.16–5.73) | 1.89 (0.0–5.72) | 85 |
Type IIa | 204/1043 | 19.6 (17.2–22.1) | 17.7 (5.60–33.9) | 97 |
Type IIb | 43/1043 | 4.12 (2.99–5.51) | 0.85 (0.0–4.02) | 85 |
Type IIa + b | 75/1043 | 7.19 (5.69–8.63) | 4.85 (0.82–11.0) | 90 |
Type III | 10/1043 | 0.96 (0.46–1.77) | 0.07 (0.0–0.85) | 34 |
Type IV | 14/1043 | 1.34 (0.74–2.24) | 0.07 (0.0–1.10) | 55 |
Type V | 1/1043 | 0.09 (0.0–0.5) | – | – |
3. Fistula location: | ||||
Left | 262/1043 | 25.1 (22.5–27.9) | 21.3 (10.0–35.2) | 95 |
Right | 282/1043 | 27.0 (24.4–29.8) | 23.3 (11.2–37.9) | 96 |
Bilateral | 91/1043 | 8.72 (7.08–10.6) | 7.41 (2.45–14.2) | 90 |
4. Cortical reflux | 383/1043 | 36.7 (33.8–39.7) | 26.5 (17.3–36.7) | 91 |
5. Clinical presentation: | ||||
Proptosis | 498/1043 | 47.8 (44.7–50.8) | 41.5 (20.9–63.5) | 98 |
Ophtalmoplegia | 344/1043 | 33.0 (30.1–35.9) | 23.5 (7.80–43.8) | 98 |
Pulsatile tinnitus | 166/1043 | 15.9 (13.7–18.3) | 10.6 (4.54–18.5) | 90 |
Pain and/or headache | 208/1043 | 19.9 (17.6–22.5) | 11.1 (2.73–23.0) | 96 |
Chemosis | 559/1043 | 53.6 (50.5–56.7) | 45.9 (22.0–70.7) | 98 |
Visual acuity reduction | 216/1043 | 20.7 (18.3–23.3) | 12.4 (4.48–23.0) | 94 |
Ocular symptoms | 153/1043 | 14.7 (12.6–17.0) | 4.96 (0.0–16.8) | 97 |
Cranial nerve palsy | 500/1043 | 47.9 (44.9–51.0) | 31.2 (16.8–47.6) | 96 |
Elevated IOP or glaucoma | 146/1043 | 14.0 (11.9–16.3) | 1.92 (0.0–9.03) | 94 |
Focal neurological deficit | 2/1043 | 0.19 (0.02–0.69) | – | – |
6. Embolization approacha: | ||||
Transarterial | 220/1066 | 20.6 (18.2–23.2) | 14.3 (7.75–22.3) | 89 |
Transvenous | 743/1066 | 69.7 (66.8–72.4) | 63.2 (50.6–65.0) | 93 |
Combined | 63/1066 | 5.91 (4.57–7.50) | 4.78 (1.80–8.72) | 78 |
Direct puncture | 1/1066 | 0.09 (0.0–0.5) | – | – |
7. Embolizing agenta: | ||||
Coils | 712/1066 | 66.8 (63.9–69.6) | 57.8 (45.4–69.7) | 93 |
Glue | 54/1066 | 5.07 (3.83–6.56) | 2.78 (0.15–7.73) | 87 |
EVOH | 47/1066 | 4.41 (3.26–5.82) | 2.97 (0.30–7.31) | 86 |
Balloon | 10/1066 | 0.94 (0.45–1.72) | – | – |
PVA | 28/1066 | 2.63 (1.75–3.77) | 0.71 (0.0–2.31) | 55 |
Liquid agents | 55/1066 | 5.16 (3.91–6.63) | 0.25 (0.0–2.47) | 82 |
Coils + glue | 33/1066 | 3.10 (2.14–4.32) | 1.43 (0.0–4.32) | 79 |
Coils + EVOH | 32/1066 | 3.0 (2.06–4.21) | 1.38 (0.0–4.54) | 82 |
Othersb | 25/1066 | 2.35 (1.52–3.44) | 0.19 (0.0–1.22) | 43 |
Outcomes (22 studies included) | Patients (n/N) | Raw proportions (95% CI) | Pooled proportions (95% CI) | I2 (%) |
---|---|---|---|---|
1. Postsurgical radiological outcome: | ||||
Complete occlusion | 599/1043 | 57.4 (54.4–60.5) | 79.5 (63.0–92.3) | 97 |
Near complete occlusion | 176/1043 | 16.9 (14.6–19.3) | 6.09 (1.16–13.5) | 92 |
Partial occlusion | 38/1043 | 3.64 (2.59–4.97) | 2.02 (0.24–3.88) | 74 |
Failed procedure | 4/1043 | 0.38 (0.10–0.98) | – | – |
2. Clinical status at final follow-up: | ||||
Resolution | 769/1043 | 73.7 (70.9–76.4) | 85.0 (69.5–96.1) | 97 |
Partial benefit | 65/1043 | 6.23 (4.84–7.87) | 2.45 (0.27–5.96) | 81 |
Persistent | 14/1043 | 1.34 (0.74–2.24) | 0.19 (0.0–1.02) | 23 |
Worsened | 16/1043 | 1.53 (0.88–2.48) | 0.22 (0.0–0.95) | 9 |
3. Complications onset | 95/1043 | 9.11 (7.43–11.0) | 7.75 (3.82–12.7) | 80 |
Patient | Sex/Age (years) | Feeders | Drainage | Barrow type | Cognard type | Cortical reflux | Treatment access | N. of treatments | Embolic agent | Angiographic outcome | Clinical outcome |
---|---|---|---|---|---|---|---|---|---|---|---|
1 | M/56 | ICAbr, AMA, APA | IPS | D | IIa | No | TFV | 1 | Coils | Complete | Resolution |
2 | F/56 | ICAbr, IMA | Sylvian vein/IPS | D | I | Yes | Autoresolutiona | – | – | – | Resolution |
3 | F/78 | ICAbr, AMA | CS-SOV/IPS | D | IIa | No | TFV/TA | 2 | Coils | Complete | Resolution |
4 | F/70 | MMA, AMA | CS-SOV | C | IIa | No | TA/TFV | 2 (1 Failed) | Onyx | Complete | Resolution |
5 | M/82 | MMA, AMA, ICAbr | CS-SOV/IPS | D | IIa | No | TFV | 1 | Coils | Complete | Resolution |
6 | F/58 | ICAbr, APA, MMA | CS-SOV | D | IIa | No | TA | 1 | Onyx | Near Complete | Resolution |
7 | M/67 | AMA, ICAbr | CS-SOV | D | IIa | No | TA | 1 | PVA | Complete | Resolution |
8 | M/38 | ICAbr, MMA, ECAbr | CS-SOV/IPS | D | IIa | No | TFV | 1 | Coils | Complete | Resolution |
9 | M/63 | APA, ICAbr | CS-SOV | D | IIa | No | TFAV | 1 | Coils | Complete | Resolution |
10 | M/74 | AMA, ICAbr | CS-SOV | D | IIa | No | TA | 1 | PVA | Complete | Resolution |
11 | M/67 | APA, MMA, ICAbr | Sphenoparietal sinus | D | III | Yes | TA | 2 | Onyx | Complete | Resolution |
12 | F/76 | ICAbr, APA, MMA, AMA | CS-Contralateral SOV | D | IIa | No | TFV/TA | 2 (1 Failed) | Coils | Complete | Resolution |
13 | F/80 | ICAbr | SOV | B | IIa | No | Autoresolutiona | – | – | – | Resolution |
14 | F/79 | AMA, APA, ECAbr, ICAbr | SOV/IPS | D | IIa + b | No | TFV | 1 | Coils | Complete | Partial benefit |
15 | F/53 | ICAbr, IMA | SOV/IPS | D | IIa | No | TFV/TA | 2 | Coils/PVA | Complete | Resolution |
16 | F/65 | IMA | SOV/IPS | C | IIa | No | TFV | 1 | Coils | Complete | Resolution |
17 | M/61 | IMA, ICAbr | SOV/IPS | D | IIa | No | TFV/TA | 2 | Coils/PVA | Complete | Resolution |