经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘(附8例报告)

目的探讨经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘的方法及效果。方法 8例海绵窦区硬脑膜动静脉瘘患者,分别经股静脉-岩下窦、股静脉-面静脉-眼上静脉、直接开放眼上静脉入路到达病变侧海绵窦,用GDC可控微弹簧圈和ONXY胶等多种栓塞材料填塞海绵窦,同时闭塞瘘口。结果 7例治疗后即刻造影显示海绵窦和瘘口完全闭塞,临床症状消失。1例虽将海绵窦闭塞,但仍残留翼丛引流,临床症状明显缓解,术后行压颈治疗后症状消失。栓塞术后最常见并发症为头痛伴呕吐及外展神经麻痹,1周后缓解。5例患者术后随访3～26个月症状未见复发,其中4例均于术后3月复查DSA未见异常,1例残留瘘口的患者术后6月行脑血管造影复查,显示残留瘘口消失。结论经静脉入路栓塞是治疗海绵窦区硬脑膜动静脉瘘安全、有效的方法。

Transvenous embolization of dural arteriovenous fistulas in cavernous regions through multiple venous routes (a report of 8 cases)

Objective To explore the method of transvenous embolization of dural arteriovenous fistulas（DAVF） in the cavernous regions and its cu~tive effect. Methods Eight patients with DAVF in the cavernous regions were treated by transvenous embolization with microcoils and Onxy gel through the inferior petrosal sinus, superior ophthalmic vein and facial vein. Results DSA immediately after the embolization showed that the fistulas were completely occluded and the clinical symptoms disappeared in 7 patients, and there was residual fistula and the clinical symptoms were improved in 1 patients, in whom the clinical symptoms disappeared by the manual compression of the carotid artery. The common complications of the embolization included headache, vomiting and the abducent nerve paralysis, which were relieved a week later. No symptoms recurred in 5 patients who were followed up from 3 to 26 mouths. DSA 6 mouths after the embolization showed that the residual fistula disappeared in the patient with residual fistula. Conclusion The transvenous embolization via different venous routes is a safe and effective method to treat DAVF in the cavernous region.