硬脑膜动静脉瘘的治疗

目的：探讨硬脑膜动静脉瘘的病因，分类及治疗。方法：26例均采用超选择插管栓塞，其4例同时行静脉入路静脉窦内栓塞，联合手术2例，X-刀治疗l例。结果：海绵窦区硬膜动静脉瘘者，17例瘘口完全消失，4例栓塞后瘘口有残留，结合颈动脉压迫法后2例瘘口消失。侧窦硬脑膜动静脉瘘者，瘘口完全消失3例，部分消失2例。结论：血管内栓塞治疗硬脑膜动静脉瘘是目前最安全、有效的治疗方法。联合手术或放射治疗等，可大大提高硬脑膜动静脉瘘的临床治疗愈率。     

海绵窦区硬脑膜动静脉瘘的栓塞治疗

目的　探讨海绵窦区硬脑膜动静脉瘘的治疗方法。方法　海绵窦区硬脑膜动静脉瘘共 12例 ,经颈外动脉以微粒栓塞 3例 ;以正丁基氰基丙烯酸异丁酯 (NBCA)栓塞 2例 ;经颈外动脉插入海绵窦以NBCA栓塞1例 ;经岩下窦以机械可脱性弹簧圈 (MDS)栓塞 1例 ;经眼上静脉以MDS栓塞 5例。结果　瘘口完全消失 8例 ;瘘口残留 4例 ,其中 2例瘘口残留患者 3个月后症状好转。结论　根据不同的类型 ,经静脉栓塞和经动脉栓塞均可作为海绵窦区硬脑膜动静脉瘘的有效治疗方法     

经动脉途径栓塞海绵窦区硬脑膜动静脉瘘

目的 探讨经动脉途径介入栓塞海绵窦区硬脑膜动静瘘的疗效和策略.方法 回顾性分析经动脉途径介入栓塞治疗的19例海绵窦区硬脑膜动静脉瘘.结果 15例临床治愈,3例明显好转,1例治疗失败.其中术后即刻造影提示12例瘘口完全消失;6例经主要供血动脉栓寒后,经瘘口血流量明显减少,压颈1个月后5例临床治愈,1例症状明显缓解.经动脉治疗失败病例改经岩下窦入路双侧海绵窦微弹簧圈栓塞后治愈.无一例出现永久性介入相关并发症.临床随访7个月到4年,病人尤临床症状复发.结论 经动脉途径介入栓塞对于部分海绵窦区硬脑膜动静瘘的病人是安全、有效且经济的治疗方法 .     

多静脉途径介入栓塞海绵窦区硬脑膜动静脉瘘

目的探讨多静脉途径介入栓塞海绵窦区硬脑膜动静脉瘘的方法、策略和疗效。方法27例海绵窦区硬脑膜动静脉瘘患者,分别经岩下窦、面静脉和眼上静脉等静脉途径介入栓塞治疗。结果23例临床治愈,4例症状明显缓解。术后即刻造影提示22例瘘口完全消失,5例虽将海绵窦致密填塞,但其中2例仍有少量翼丛引流,1例通过海绵间窦向对侧引流,2例存在少量岩上窦后引流,压颈1个月后消失。栓塞术后并发症主要表现为头痛和呕吐,3例出现轻度复视,后自行恢复;无1例出现永久性介入相关并发症。临床随访5个月～6年,患者无临床症状复发。结论多静脉途径介入栓塞是治疗海绵窦区硬脑膜动静脉瘘安全、有效的方法。     

经岩下窦介入栓塞海绵窦区硬脑膜动静脉瘘3例临床分析

目的 探讨经静脉人路栓塞治疗海绵窦区硬脑膜动静脉瘘的效果.方法 经股静脉-岩下窦入路到达病变侧海绵窦,用游离弹簧圈等多种栓塞材料填塞海绵窦,同时闭塞瘘口.结果 3例中全部愈或好转,1例在栓塞治疗后眼部症状消失.栓塞术后最常见症状为头痛伴呕吐.随访3个月到5年未见复发.结论 静脉入路栓塞治疗硬脑膜动静脉瘘是一种安全、有效的方法,应作为首选治疗方法.     

海绵窦区硬脑膜动静脉瘘的诊断与治疗探讨

目的:探讨海绵窦区硬脑膜动静脉瘘的临床表现及治疗方法?方法:回顾性分析南京医科大学附属无锡第二医院2005年1月~2011年6月收治的10例海绵窦区硬脑膜动静脉瘘病例的临床资料及随访情况?2例行颈动脉压迫治疗,4例经动脉入路采用Onyx栓塞治疗,4例经静脉入路栓塞治疗,其中1例采用单纯微弹簧圈栓塞,1例采用单纯Onyx栓塞,2例采用Onyx结合微弹簧圈栓塞?所有患者随访6个月~3年?结果:2例压颈治疗患者症状体征完全消失,6个月后复查DSA见瘘已消失,4例经动脉入路治疗患者瘘口完全闭塞,4例经静脉入路患者中3例瘘口完全闭塞,1例有轻度残留,但症状好转?结论:海绵窦区硬脑膜动静脉瘘的临床表现以眼部症状为主,易误诊?供血单纯?流量低的患者可通过压颈治疗治愈?血管内栓塞治疗安全?效果好,应根据DSA表现个体化选择栓塞入路?     

弹簧圈栓塞介入治疗难治性颈动脉海绵窦瘘7例

目的：探讨弹簧圈介入治疗难治性颈动脉海绵窦瘘的适应证及治疗技术要点。方法：所有病例经股动脉或股静脉穿刺插管，在数字减影血管造影监视下行弹簧圈介入治疗。结果：经动脉途径成功栓塞5例颈动脉海绵窦瘘。经静脉途径成功栓塞2例颈动脉海绵窦区硬脑膜动静脉畸形，1例为岩下窦途径，1例为眼静脉和岩下窦途径。结论：难治性颈动脉海绵窦瘘可以用弹簧圈栓塞介入治疗，是一项极有价值的治疗方法。     

经静脉入路栓塞治疗颈动脉海绵窦瘘

目的评估经静脉人路栓塞治疗颈动脉海绵窦瘘(CCF)的方法.方法回顾性分析17例经静脉入路栓塞治疗颈动脉海绵窦瘘患者,其中女性14例,男3例;Banow A型1例,B型1例,C型1例,D型14例.结果经岩下窦人路栓塞海绵窦9例,经眼静脉人路栓塞6例,经两种人路栓塞1例(双侧瘘).12例治疗后即刻造影显示海绵窦和瘘口完全闭塞;4例虽海绵窦闭塞,但仍残留少许岩下窦的引流(2例为眼静脉人路者)和翼丛引流(2例).1例面静脉-眼静脉人路,插管过程中面静脉痉挛,手术失败,患者在5 d后自发症状缓解,7 d后动脉造影显示CCF已自愈.结论经静脉入路栓塞颈动脉海绵窦瘘,特别是海绵窦区硬脑膜动静脉瘘(DAVF),效果确实,操作风险小.     

可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘

目的：探讨可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘的临床意义。方法：应用可脱性球囊经动脉途径栓塞治疗21例颈内动脉海绵窦瘘。结果：21例患者中,瘘口栓塞17例,闭塞颈内动脉4例,均治愈。其中瘘口栓塞后1例并发球囊早泄瘘口复发,经再次球囊栓塞成功。颈内动脉通畅率为80.9%。随访3-6个月未见复发。结论：可脱性球囊栓塞术是治疗外伤性颈内动脉海绵窦瘘的首选术式。     

颈动脉—海绵窦瘘几种治疗方法的评价

目的：报道经不同方法治疗２１例颈动脉－海绵窦瘘（ＣＣＦ），就其结果进行了评价，方法：颈总动脉切开肌肉片“放风筝”４例，开颅穿刺海绵窦马尾填塞６例，股动脉穿刺微导管球囊栓塞１０例，眼上静脉穿刺弹簧圈栓塞１例。结果：“放风筝”治愈１例，既闭塞瘘口又保持动脉通畅，２例颈动脉闭塞，１例瘘口及海绵窦部分闭塞，开颅穿刺海绵窦马尾填塞４例，ＣＣＦ消失，颈动脉保持通畅，２例ＣＣＦ大部分栓塞，６例术后均出现不同程度     

Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula

Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach. Methods From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins. Results Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external     

经静脉入路栓塞治疗硬脑膜动静脉瘘27例临床分析

目的探讨经静脉途径栓塞治疗硬脑膜动静脉瘘(DAVF)的疗效.方法经全脑血管造影(DSA)确诊硬脑膜动静脉瘘27例,其中海绵窦区18例,横窦、乙状窦9例,均经静脉途径予以栓塞治疗.结果本组27例中治愈22例,症状好转5例,无加重和死亡.随防2个月～8年,无复发及加重者.结论静脉入路栓塞治疗硬脑膜动静脉瘘是一种安全、有效的方法.     

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases

Background  Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.
Methods  From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.
Results  All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.
Conclusions  Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

     

硬脑膜动静脉瘘的分型及临床意义

目的：探讨硬脑膜动静脉瘘（DAVF）的影像学分类及临床意义。方法：对110例DAVF患者,121个病变按部位进行分区,分别为硬膜窦区,海绵窦区,天幕区,颅底静脉丛区,大脑镰区。按引流静脉分类,Ⅰ型瘘口直接向脑膜静脉或硬脑膜窦引流;Ⅱ型向硬脑膜窦回流后反流入脑或脊髓静脉。Ⅲ型直接向脑或脊髓静脉回流。结果：结合部位和引流静脉对本组病例分类结果为：海绵窦区Ⅰ型38例（69．1％）,Ⅱ型17型30．9％,硬膜窦区Ⅰ型11例（33．3％）,Ⅱ型16例（56．4％）,Ⅲ型2例（10．3％）;而天幕区20例,颅底静脉丛6例,大脑镰区1例均为Ⅲ型。结论：相同部位不同引流静脉类型治疗不同,相同引流静脉类型不同部位治疗各异,部位和引流静脉类型联合分类有助分析临床风险和制定治疗方案。     

Transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes

Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistula of cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results： Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete anglographic obliteration was documented in 22 patients （82%）. Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization. There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion： Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.     

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via

Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.