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.     

通过静脉入路栓塞治疗难治性颈动脉海绵窦瘘

目的 探讨经静脉入路栓塞治疗难治性颈动脉海绵窦瘘的效果,面临的问题及相应的处理。方法 应用经股静脉-岩下窦人路和经股静脉-面静脉-眼上静脉人路两种静脉人路对25例难治性颈动脉海绵窦瘘患者的28侧海绵窦进行了栓塞治疗,其中经股静脉-岩下窦人路16侧,经股静脉-面静脉-眼上静脉人路12侧。用电解可控弹簧圈（GDC、EDC）、游离弹簧圈和丝线等多种栓塞材料填塞病变侧海绵窦,同时闭塞瘘口。术后3到24个月对10例进行了脑血管造影复查。对其他15例进行了电话随访。结果 20例治疗后即刻造影显示海绵窦和瘘口完全闭塞。5例虽将海绵窦闭塞,但仍残留岩下窦的引流（3例）和翼丛引流（2例）。栓塞术后常见症状为头痛伴呕吐。5例残留瘘口的患者中4例术后行脑血管造影复查,其中2例残留瘘口消失,1例残留岩下窦引流,1例残留翼丛引流。6例瘘口完全闭塞患者术后行脑血管造影检查未发现复发,其余14例瘘口完全闭塞患者经电话随访未出现症状。结论 经静脉人路栓塞治疗难治性颈动脉海绵窦瘘安全有效,对于经动脉途径治疗失败的颈动脉海绵窦瘘,经静脉入路栓塞可作为首选治疗。     

血管内栓塞治疗颈动脉海绵窦瘘

目的 探讨颈动脉海绵窦瘘血管内栓塞治疗。方法 回顾性分析2003年至2005年收治的9例患者，所有患者均行全脑血管数字减影血管造影检查明确诊断。根据供血动脉进行影像分型，不同类型选择了不同的治疗方法。6例A型病例经动脉途径进行球囊栓塞，1例C型病例及1例D型病例经静脉途径进行弹簧圈栓塞。结果 5例A型病例一次可脱性球囊闭塞瘘口成功，1例A型病例球囊早泄复发、2周后再次球囊栓塞成功，1例C型病例经眼上静脉2次弹簧圈填塞海绵窦治愈，1例D型病例经岩下窦一次填塞海绵窦治愈。1例A型病例造影后当天因颅内再次出血死亡。结论 根据不同影像分型选择相应的治疗方法是提高颈动脉海绵窦瘘栓塞治疗疗效的关键。     

经岩下窦静脉入路栓塞治疗外伤性颈内动脉海绵窦瘘

外伤性颈内动脉海绵窦瘘（traumatic internal carotid artery cavernous sinus fistula ,TCCF）的治疗模式,已从最初的经动脉入路可脱性球囊栓塞的单一方式,发展到经动脉或静脉途径,应用或联合应用弹簧圈、可解脱球囊、液态栓塞剂（NBCA 或者Onyx胶）、血管内支架等多种治疗模式［1‐2］。经静脉入路使用可解脱弹簧圈或联合应用液态栓塞剂已成为TCCF的一种重要的血管内治疗方法。2009年1月－2013年7月,笔者科室共收治9例经静脉入路治疗的 TCCF患者,现回顾性分析其临床资料,并结合文献进行分析探讨。     

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。     

颈动脉—海绵窦瘘的诊断和栓塞治疗

目的：本文报告７６例颈动脉－海绵窦瘘及其栓塞治疗。方法：本组均经股动脉和患侧颈动脉入路，选用可脱球囊、微螺旋圈和聚乙烯醇颗粒进行栓塞处理。结果：７５例栓塞成功，仅１例塞后有部分瘘口未完全闭合，５８例（８３％）颈内动脉得以保留。结论：本组体会，颈动脉海棉窦瘘有颈内外动脉复合型，颈内动脉型和颈外动脉型；依不同的类型选用不同的材料和方法栓塞要提高治疗效果，特别是助于颈内动脉的保留。     

经动脉途径血管内栓塞治疗外伤性颈动脉海绵窦瘘

目的回顾分析38例外伤性颈动脉海绵窦经动脉途径的血管内栓塞治疗效果。方法32例单纯使用可脱球囊栓塞,5例使用弹簧圈辅助栓塞,1例使用NBCA胶辅助栓塞。结果30例成功闭塞瘘口且保留颈内动脉通畅,8例闭塞颈内动脉,没有发生严重并发症。结论经动脉途径血管内栓塞治疗是外伤性颈动脉海绵窦瘘安全有效和首选的治疗方法。     

血管内栓塞治疗外伤性颈动脉海绵窦瘘的护理

目的：探讨外伤性颈动脉海绵窦瘘（TCCF）血管内栓塞术的围手术期护理。方法：回顾性总结我科2002年7月-2006年6月15例外伤性颈动脉海绵窦瘘施行血管内栓塞患者围手术期的护理经验。结果：15例均行脑血管造影和血管内治疗，术中采用闭塞TCCF的瘘口或闭塞颈内动脉，15例患者均完全栓塞，颈内动脉闭塞6例，术后无并发症，随访3个月-3年，无复发。结论：血管内栓塞是治疗外伤性颈动脉海绵窦瘘的理想方法，全面细致的围手术期护理，密切观察病情，预防并发症发生是手术成功的保证。     

微弹簧圈栓塞难治性外伤性颈动脉海绵窦瘘的临床研究

目的　探讨和研究用微弹簧圈血管内栓塞部分难治性外伤性颈动脉海绵窦瘘。方法　回顾 2 4例用微弹簧圈或结合其它栓塞材料栓塞治疗的难治性外伤性颈动脉海绵窦瘘 ,18例经动脉入路用微弹簧圈栓塞治疗 ,3例经岩下窦入路 ,另 3例经眼静脉入路。 7例首次用弹簧圈栓塞 ,另 17例弹簧圈结合球囊、NBCA(α -氰基丙烯酸正丁酯 )等栓塞材料栓塞。结果　栓塞术后血管造影结果示 ,7例较前改善 ,17例达到治愈。临床结果 :2 1例(87.5 % )治愈 ,3例 (12 .5 % )明显改善 ,无恶化者。随访时间为 6 - 2 4个月临床均达治愈 ,无复发。结论　球囊栓塞困难的小瘘口型外伤性颈动脉海绵窦瘘可选用微弹簧圈栓塞 ,其疗效可靠且安全。对复发或多次治疗后形成的复杂难治性外伤性颈动脉海绵窦瘘也可选用弹簧圈或结合其它栓塞材料联合治疗     

创伤性颈动脉海绵窦瘘的介入栓塞治疗

目的：探讨创伤性颈动脉海绵窦瘘的临床表现和血管内介入栓塞治疗效果。方法：回顾性分析本组共12例创伤性颈动脉海绵窦瘘的临床表现，采用可脱性球囊微导管技术经股动脉途径闭塞颈内动脉破口处。结果：全部病例均一次性治愈，11例成功地闭塞了瘘口，颈内动脉主干保持通畅（11／12），1例同时闭塞了瘘口及颈内动脉主干。11例获随访6mo-4.2a，无复发。结论：采用可脱性球囊栓塞技术是治疗创伤性颈动脉海绵窦瘘的首选方法。     

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。     

可脱性球囊血管内治疗外伤性颈内动脉海绵窦瘘(附112例报告)

目的探讨用可脱性球囊栓塞技术治疗高流量外伤性颈内动脉海绵窦瘘的方法及疗效.方法回顾性分析112例采用可脱性球囊栓塞技术治疗的高流量外伤性颈内动脉海绵窦瘘患者的临床资料,全部患者均经全脑数字减影血管造影术明确诊断.结果采用可脱性球囊栓塞后,瘘口闭合且颈内动脉通畅97例(87.6%),瘘口闭合但颈内动脉闭塞15例.术后随访2个月至9年,复发4例,行二次栓塞后无复发.本组病例均无合并症.结论可脱性球囊栓塞技术是治疗高流量外伤性颈内动脉海绵窦瘘的首选术式.     

栓塞治疗外伤性颈内动脉海绵窦瘘

目的：探讨外伤性颈内动脉海绵窦瘘（TCCF）的神经血管介入治疗技术。方法：应用法国Bait公司的可脱性球囊,在数字检影脑血管造影（DSA）监视下对32例TCCF患者施行可脱性球囊治疗,其中27例效果满意,另5例结合GDC弹簧圈,3例单纯用GDC弹簧圈栓塞治疗均取得满意的效果。结果：7例患者闭塞瘘口同时闭塞了颈内动脉,术后13例失明未恢复,其余病例治疗效果良好。结论：血管内治疗技术,尤其是可脱性球囊技术是目前治疗TCCF的最好方法,其具有损伤小、安全性高和疗效可靠的特点。     

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.

     

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。     

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.     

Transvenous treatment of a complex cavernous sinus dural arteriovenous fistula secondary to balloon embolization of a traumatic carotid-cavernous fistula

Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2- cyanoacrylate （NBCA）. The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.