Onyx结合弹簧圈岩下窦入路栓塞海绵窦区硬脑膜动静脉瘘

目的：探讨应用Onyx结合弹簧圈岩下窦入路栓塞海绵窦区硬脑膜动静脉瘘（csDAVF）的优势及疗效。方法：对6例csDAVF患者应用Onyx结合弹簧圈岩下窦入路栓塞,并评价疗效。结果：6例采用＂股静脉-岩下窦＂入路成功栓塞csDAVF,4例csDAVF瘘口完全闭塞,出院时症状消失;2例csDAVF次全闭塞,出院时症状改善,随访1-2个月临床症状消失。全部病例随访1-12个月,未见症状复发。结论：经＂股静脉-岩下窦＂途径,较易到达病变部位;海绵窦为闭塞csDAVF瘘口的理想部位,Onyx能在海绵窦中形成良好弥散,结合弹簧圈的应用有利于瘘口的闭塞。     

创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤的诊断和治疗

目的 探讨创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤的诊疗方法.方法 介入方法诊断和治疗6例创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤患者.结果 5例出现反复鼻腔大出血;所有患者均行瘘口和假性动脉瘤球囊闭塞,2例颈内动脉保留,1例合并对侧间接型颈动脉海绵窦瘘行经面静脉-眼上静脉瘘口弹簧圈栓塞术.术后颅内杂音均即刻消失,结膜充血水肿2周～3个月内消退.无介入相关并发症.所有患者均行随访,无临床症状复发,均恢复工作.结论 车祸是致颈动脉海绵窦瘘合并蝶窦假性动脉瘤的主要原因;受力部位多集中在患侧眶额部到眶颧部的眶前外侧区;头颅MRI结合临床表现对于术前确诊该病非常有帮助;可脱球囊闭塞瘘口和假性动脉瘤或闭塞颈内动脉是安全、有效的治疗方法.     

外伤性颈内动脉海绵窦瘘的血管内治疗

目的:总结应用多种血管内技术治疗外伤性颈内动脉海绵窦瘘(TCCF)的经验体会。方法:自2003年11月~2007年11月收治TCCF 16例。14例患者单纯应用可脱球囊治疗,1例应用可脱弹簧圈结合NBCA栓塞治疗,1例患者应用可脱球囊治疗失败后应用了覆膜支架治疗。结果:14例应用球囊成功栓塞瘘口,另2例分别应用可脱弹簧圈结合NBCA和覆膜支架最终治疗成功。14例闭塞瘘口并保留了颈内动脉,2例闭塞瘘口的同时闭塞了颈内动脉。无死亡以及手术相关性并发症。随访6~24个月(平均18个月),无1例复发。结论:多种血管内技术可以安全、有效地治疗外伤性颈内动脉海绵窦瘘。首选球囊闭塞瘘口,在球囊闭塞瘘口失败时可考虑应用可脱弹簧圈或覆膜支架。     

MR扩散加权成像诊断食管癌的效能

确定血管内弹簧圈栓塞海绵窦的成功率及急性并发症的发生率。对19例直接（13例）或硬脑膜动静脉瘘（AVF）f6例）病人行海绵窦弹簧圈栓塞治疗。治疗目的是完全闭塞瘘口。对闭塞程度、症状的减轻及并发症发生率进行回顾性分析。12例病人术后瘘口完全闭塞,6例部分闭塞,1例病人未闭塞并残存较大瘘口。2例AVF早期复发的病人经再次手术后治愈。随访显示,16例病人完全闭塞,3例病人部分闭塞。所有病人结膜水肿及眼球突出均迅速缓解。     

颅底动脉损伤的介入治疗

目的 探讨多种血管腔内手段治疗颅底动脉损伤的临床价值.方法 2004年10月至2007年5月间我院收治各类型颅底动脉损伤患者共53例,均有头颈部外伤史.主要症状为搏动性突眼和颅内血管杂音(39例)、声嘶或吞咽不适(9例)、鼻出血(5例)等;DSA检查证实颈动脉海绵窦瘘(carotid cavemous fistulae,CCF)39例,颈内动脉假性动脉瘤14例;针对上述53例患者不同的病变特点采用不同的血管腔内治疗,并通过电话或门诊随访.结果 对53例患者56支颈内动脉进行了腔内介入治疗,采用单纯可脱球囊栓塞治疗CCF'33例34支血管,可脱球囊联合弹簧圈栓塞3例,植入覆膜支架封堵CCF3例;采用单纯可脱球囊闭塞颈内动脉治疗假性动脉瘤8例,可脱球囊联合弹簧圈孤立假性动脉瘤2例,植入覆膜支架腔内隔绝治疗4例;平均随访时间9.5个月(2～25个月),85%(45/53)患者主诉症状于6个月内消失,12个月随访15%(8/53)患者遗留眼球运动受限或视力障碍.复查显示存在假性动脉瘤6例,残瘘3例,其中2例因海绵窦区的硬脑膜动静脉瘘而分别于术后第2、3个月行再次介入治疗.结论 对各型颅底动脉损伤,血管腔内介入治疗创伤小且安全有效.尽管存在缺陷,可脱球囊仍是治疗CCF和颈动脉假性动脉瘤的首选方法,在特殊情况下必需联合应用弹簧圈栓塞和覆膜支架植入等多种治疗手段.     

外伤性颈内动脉海绵窦瘘并严重鼻衄的血管内介入治疗

目的 探讨血管内介入治疗外伤性颈内动脉海绵窦瘘(TCCF)合并严重鼻衄的策略和疗效.方法 26例TCCF并严重鼻衄的患者进行了血管内介入治疗,其中24例采用了可脱性球囊栓塞瘘口或闭塞颈内动脉;1例采用解脱式微弹簧圈栓塞;1例采用覆膜支架进行治疗.结果 26例中,9例1次性栓塞了瘘口,假性动脉瘤消失,颈内动脉通畅;15例1次性栓塞了瘘口和闭塞颈内动脉;解脱式微弹簧圈栓塞海绵窦,瘘口基本消失,颈内动脉通畅1例;覆膜支架闭塞瘘口,颈内动脉保持通畅1例.术后26例均未再发生鼻衄.结论 TCCF并严重鼻衄应尽早进行DSA确诊,尽早或急症进行治疗.血管内介入治疗TCCF合并严重鼻衄是一种首选、安全和有效的治疗方法.     

带膜支架治疗右侧外伤性颈动脉海绵窦瘘一例

报道1例右侧外伤性颈动脉海绵窦瘘(traumatic carotid cavernous fistula,TCCF),采用带膜支架封堵术完全闭塞瘘口并且保持颈内动脉通畅.     

创伤性颈内动脉海绵窦瘘的介入治疗

目的:探讨不同类型的创伤性颈内动脉海绵窦瘘的介入治疗方法。材料和方法:回顾性分析63例经全脑数字减影血管造影(DSA)诊断的创伤性颈内动脉海绵窦瘘的治疗方法:血管内栓塞、栓塞结合手术孤立瘘口或瘘口所在的颈内动脉内覆膜支架置入等方式。结果:63例创伤性颈动脉海绵窦瘘中,术后59例动静脉瘘完全闭塞,4例大部分闭塞;临床症状消失62例,好转1例。本组无并发症发生。结论:创伤性颈内动脉海绵窦瘘治疗的关键在于闭塞瘘口。根据其动静脉瘘的部位、供血动脉及瘘口的数量、引流静脉的特点等综合考虑栓塞材料的选择是保证治疗成功的重要因素。     

颈动脉海绵窦瘘的眼眶CT表现(附23例报告)

目的分析２３例经ＤＳＡ检查证实的颈动脉海绵窦瘘的眼眶ＣＴ表现。材料与方法本组２３例，其中有外伤史者１５例，占６５％。颈内动脉海绵窦瘘（ＣＣＦ）１４例，硬脑膜动脉海绵窦瘘９例。均行眼眶ＣＴ检查并经ＤＳＡ造影证实。结果主要ＣＴ表现为：（１）眼球突出；（２）眼上静脉扩张；（３）海绵窦增大；（４）眼外肌增粗；（５）眶内软组织肿胀。结论对突眼的病人进行ＣＴ扫描，发现有上述表现时可考虑颈动脉海绵窦瘘的诊断，但应进行必要的鉴别诊断，ＤＳＡ检查可明确瘘的部位和类型，并可决定治疗的方法     

经面静脉-眼上静脉入路治疗颈动脉海绵窦瘘

目的　评价经面静脉 眼上静脉入路治疗颈动脉海绵窦瘘 (CCF)的有效性。方法 :经股静脉 面静脉 眼上静脉入路到达患侧海绵窦 ,用GDC或EDC ,游离弹簧圈 ,真丝线段等多种栓塞材料填塞海绵窦 ,同时闭塞瘘口。面静脉插管困难者 ,在下颌角附近切开皮肤显露面静脉 ,直视下穿刺面静脉放置相应导管 ,再经眼上静脉到达患侧海绵窦并将其填塞。结果 :经面静脉 眼上静脉入路对 14例、16侧海绵窦进行了栓塞治疗 ,其中 5例为外伤性、直接CCF(A型 ) ,经动脉途径球囊栓塞后复发 ,或微弹簧圈栓塞未能成功 ,或经岩下窦入路未能成功 ,9例为自发性、间接CCF(D型 8例 ,C型 1例 )。 13例经股静脉 面静脉 眼上静脉途径 ,1例通过直视下面静脉穿刺。 11例栓塞治疗后即刻造影显示瘘消失 ,2例残留低流量的岩下窦引流 ,另有 1例在微导管进入面静脉后 ,面静脉痉挛闭塞 ,未能继续进行栓塞治疗 ,造影仍见瘘存在 ,但眼静脉出现明显的造影剂滞留。 1例A型CCF在球囊栓塞后出现外展神经麻痹 ,经面静脉 眼上静脉栓塞后亦无改善。因面静脉痉挛闭塞未能栓塞成功者 ,于术后即感眼部症状加重 ,但第 2天感症状缓解 ,术后第 2 1天症状明显改善 ,造影检查发现瘘口已经消失 ,术后 1个月患者眼部症状完全消失。其他病例在栓塞术后眼部症状明显改善 ,     

经动脉入路血管内治疗142例创伤性颈内动脉海绵窦瘘临床分析

目的 验证经动脉入路血管内治疗对创伤性颈内动脉海绵瘘(CCF)的治疗效果.方法 142例经全脑血管造影确诊为颈内动脉海绵窦瘘,行常规可脱球囊栓塞术,其中7例行球囊栓塞失败,改为全麻下行Jostent覆膜支架成形术.结果 135例患者局麻下成功行可脱球囊栓塞术,7例行球囊栓塞失败后于全麻下成功行Jostent覆膜支架成形...     

Treatment of carotid cavernous fistulas using covered stents: midterm results in seven patients

BACKGROUND AND PURPOSE: Carotid cavernous fistulas (CCF) can be effectively treated by using different therapeutic alternatives such as detachable balloons and detachable coils, alone or in combination with N-butyl-2-cyanoacrylate (n-BCA) or Onyx. Stents have also been used in an attempt to improve preservation of the parent artery while still occluding the fistula. We present our experience using balloon-expandable covered stents to treat CCF, focusing on arterial wall reconstruction. To our knowledge, this is the first series with midterm follow-up between 3 months and 3.5 years. MATERIALS AND METHODS: From the 46 CCF treated at our institution between November 1998 and September 2006, a total of 7 posttraumatic direct CCF were treated using polytetrafluoroethylene (PTFE)-covered stents between April 2003 and September 2006. Five were treated with covered stents alone. One patient with transection of the internal carotid artery (ICA) first underwent bare stent placement to provide support for the covered stent. One patient had to be treated with coils and n-BCA. RESULTS: Control angiograms obtained in the 7 patients demonstrated occlusion of the fistula and preservation of the ICA in all cases. There was no mortality and no immediate postprocedural morbidity. There was 1 case of morbidity identified at 1-month follow-up with asymptomatic occlusion of the ICA; the other 6 patients had angiographic follow-up between 3 and 42 months (mean, 18.4 months), with persistent occlusion of the fistulas, patent stent grafts, and no significant intimal hyperplasia. CONCLUSIONS: PTFE-covered stents are evolving as a promising intracranial therapeutic alternative to treat CCF and preserve the parent artery by reconstructing the arterial wall. They should be considered in patients in whom fistulas cannot be successfully occluded with detachable balloons or detachable coils. More investigation is required to further develop their specifications and indications.     

外伤性颈内动脉海绵窦瘘的诊断及血管内栓塞治疗

目的探讨外伤性颈动脉海绵窦瘘(TCCF)的诊断方法和血管内球囊及可脱式弹簧圈(GDC)栓塞治疗的效果。方法回顾性研究48例患者共49个瘘口进行51次栓塞治疗,其中49次应用可脱式球囊进行栓塞,2次应用GDC进行栓塞。结果49个瘘口中31个闭塞瘘口同时颈内动脉保持通畅,2例患者2周后复发,应用球囊再次栓塞。18个闭塞患侧颈内动脉,1例患者出现暂时性肢体偏瘫。2例GDC栓塞闭塞瘘口并保持颈内动脉通畅。患者临床症状基本全部消失,部分术前视力下降者恢复不良。结论物理诊断和DSA脑血管造影对TCCF诊断最有意义。可脱式球囊栓塞是治疗TCCF的良好方式,辅助GDC栓塞总体上可以达到更好的结果。     

Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels – three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses – by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded. Received: 17 March 1999 Accepted: 27 April 1999     

颈动脉海绵窦瘘的血管内栓塞治疗

目的　探讨不同的栓塞材料在颈动脉海绵窦瘘 (CCF)的血管内栓塞治疗中的应用。方法　回顾分析了 2 3例CCF血管内栓塞治疗病例。其中 2 2例外伤性CCF ,19例使用了可脱性球囊 ,3例使用了金属微弹簧圈作栓塞材料 ;1例自发性CCF ,使用了NB CA胶作栓塞剂。结果　可脱性球囊栓塞 19例 ,均获得临床治愈 ,其中 12例保持了患侧颈内动脉的通畅 ,获得解剖治愈 ;金属微弹簧圈栓塞 3例 ,2例成功 ,1例因弹簧圈异位栓塞于右大脑中动脉的分支 ,导致病人失语和半身不遂 ,1例自发性CCF ,经患侧脑膜副动脉注射NBCA胶 ,部分NBCA进入海绵窦内 ,病人获得临床治愈。结论　CCF首选血管内栓塞治疗 ,而可脱性球囊是一种理想的栓塞材料。由于金属微弹簧圈可控性差 ,不够安全 ,不应再被作为经颈内动脉途径的栓塞材料。     

双导管球囊技术治疗高流量颈动脉海绵窦瘘

目的探讨双球囊导管技术治疗高流量颈动脉海绵窦瘘(CCF)的可行性及疗效。方法随机选择1枚可脱性球囊无法闭塞的CCF患者3例,双侧股动脉置管,送2枚球囊进入瘘口,调整位置,充盈2枚球囊,使瘘口完全闭塞后再解脱球囊,观察栓塞效果和颈内动脉通畅情况,评价该技术的可行性。结果3例患者均1次性完全闭塞瘘口,颈内动脉皆通畅,操作过程简单易行,未增加介入治疗的危险性。结论双导管球囊技术能在保证颈内动脉通畅的前提下简单有效地治疗1枚球囊无法闭塞的CCF。     

直接型颈动脉海绵窦瘘的血管内治疗

探讨血管内治疗对直接型颈动脉海绵窦瘘的价值。材料和方法：38例患者在治疗前均行脑血管造影检查，所有病例均采用经动脉途径，用可脱球囊导管进行栓塞治疗。结果：38例患者中有36例栓塞成功，其中34例患者瘘口完全闭塞。36例患者中有32例于栓塞后保留颈内动脉，4例行颈内动脉球囊闭塞术。术后36例患者的海绵窦综合症均有不同程度的好转。3例患者曾行经静脉途径可脱球囊栓塞治疗，但由于海绵窦内分隔的阻挡作用，球囊不能进入海绵窦及其瘘口附近而告失败。2例患者由于球囊早脱并移位于大脑中动脉分支血管内，导致患者发生失语和一侧肢体偏瘫。结论：血管内可脱球囊栓塞治疗直接型颈脉海绵窦瘘，其瘘口闭塞率高，死亡率低，是直接型颈动脉海绵窦瘘的首选治疗手段。     

Treatment of a direct carotid-cavernous fistula in a patient with type IV Ehlers-Danlos syndrome: a novel approach

We report a case of a 34-year-old female with type IV Ehlers-Danlos syndrome diagnosed with a carotid cavernous fistula presenting with progressive proptosis. Endovascular embolization using balloons or coils carries a high risk of complications in this group of patients, owing to the extreme fragility of the blood vessels. Initial treatment was conservative until an intracerebral haemorrhage occurred. To avoid transfemoral angiography, the ipsilateral carotid arteries and the internal jugular vein were surgically exposed for insertion of two endovascular sheaths. The patient was transferred from theatre to the angiography suite and the sheaths were used for embolization access. The fistula was closed, with preservation of the carotid artery, using Guglielmi detachable coils deployed in the cavernous sinus from the arterial and venous sides. Rapid resolution of symptoms and signs followed, which was sustained at 6-month follow-up. This technique offers alternative access for endovascular treatment, which may reduce the high incidence of mortality associated with catheter angiography in this condition.