颈动脉海绵窦瘘可脱性球囊栓塞术后瘘口再通原因与治疗

目的探讨可脱性球囊栓塞治疗颈动脉海绵窦瘘（CCF）术后瘘口再通原因与治疗方法。方法回顾性分析12例CCF术后瘘口再通的原因、类型及相对应的治疗方法,随访时间为6个月~2 a。结果12例瘘口再通均在术后1周内发生,3例为球囊早泄,5例为球囊破裂,4例为球囊移位。10例再次用球囊栓塞治愈,2例行3次球囊栓塞成功。其中闭塞颈内动脉5例,未出现并发症。结论用可脱性球囊栓塞治疗CCF的复发与有无颅底骨折片、球囊大小的选择、球囊的充盈状态、放置位置及瘘口大小等有关。     

血管内介入治疗外伤性颈动脉-海绵窦瘘存在的问题

目的总结血管内介入治疗外伤性颈动脉一海绵窦瘘(TCCF)中存在的一些问题，探讨避免引起这些问题的技术方法。方法以可脱性球囊栓塞治疗68例TCCF患者，共进行栓塞术75次。1例经颈部切开穿刺，以球囊栓塞；2例经眼静脉入路以微弹簧圈栓塞海绵窦，其余则经股动脉入路栓塞。结果颈内动脉通畅率为66．2％，有3例在瘘口近端闭塞颈内动脉，有5例在栓塞术后3d内球囊过早泄漏，再次行栓塞术，1例栓塞瘘口后出现假性动脉瘤，1例出现眼静脉的动静脉瘘。结论以可脱性球囊栓塞TCCF是可靠的方法，但目前球囊的性能有待提高，以微弹簧圈栓塞海绵窦瘘可提高颈内动脉通畅率．双侧股动脉穿刺置管可减少并发症。     

血管内栓塞术治疗颅脑损伤后假性动脉瘤破裂8例

对8例颅脑损伤后假性动脉瘤破裂患者行血管内栓塞术，手术经右侧股动脉入路，用球囊、弹簧圈闭塞瘘口或颈内动脉栓塞，结果3例可脱球囊一次栓塞成功，保留颈内动脉通畅；1例颈内动脉放置2枚球囊，连同颈内动脉闭塞；3例应用游离弹簧圈连同颈内动脉闭塞；1例因反复球囊被骨片刺破而改行孤立手术。随访1～5a未复发。认为血管内栓塞术是治疗假性动脉瘤的首选方法。     

旋转DSA配合介入栓塞治疗老年自发性颈动脉海绵窦瘘

目的 探讨介入栓塞治疗老年自发性颈动脉海绵窦瘘的效果及旋转数字减影血管造影术(DSA)和三维血管重建在显示瘘口位置、大小及与周围血管关系中的应用.方法 经动脉入路对11例老年自发性颈动脉海绵窦瘘患者进行栓塞治疗,应用旋转DSA和三维血管重建寻找瘘口,采用可脱性球囊、电解可控弹簧圈(GDC)等多种材料栓塞病变侧海绵窦,同时闭塞瘘口.术后6～24个月对全部11例患者进行全脑血管造影复查.结果 9例行球囊及GDC栓塞瘘口的患者术后即刻造影显示瘘口完全闭塞,2例患侧颈内动脉完全闭塞,无复发.结论 在旋转DSA和三维血管重建的配合下栓塞老年自发性颈动脉海绵窦瘘是一种安全、有效的治疗方法.     

球囊辅助弹簧圈联合Onxy胶治疗颈内动脉海绵窦瘘的疗效分析

目的探讨球囊辅助弹簧圈联合Onxy胶治疗颈内动脉海绵窦瘘（CCF）的安全性及有效性。 方法四川省医学科学院·四川省人民医院神经外科自2018年1月至2020年6月共收治CCF患者19例,均采用球囊辅助弹簧圈联合Onxy胶介入治疗。其中11例岩下窦开放者行经岩下窦静脉途径栓塞治疗,另8例行经颈内动脉瘘口动脉途径栓塞。 结果19例患者栓塞后即刻造影显示海绵窦瘘口完全封闭。术后常规复查头颅CT,未见栓塞剂异位栓塞表现,无新发神经功能障碍表现。所有患者于术后即刻眼静脉症状及颅鸣耳鸣症状均有明显缓解,1~2周内逐步消失。而存在颅神经麻痹症状患者,眼外肌麻痹症状缓解则相对缓慢。 结论通过三维成像后处理剪辑技术,可精准判断瘘口位置;无论经动脉或静脉入路,封堵球囊可精准封闭瘘口,在栓塞过程中使弹簧圈及Onxy胶尽可能接近瘘口附近,从而减少费用,同时提高CCF治疗的安全性及有效性,减少并发症。     

可脱性球囊治疗颈内动脉-海绵窦瘘的远期效果

使用可脱性球囊经动脉栓塞颈内动脉-海绵窦瘘(CCFs)是栓塞瘘口和保护颈内动脉的最好的首选方式。在使用乳胶和硅胶可脱性球囊治疗的100例CCFs中,成功栓塞了88个瘘口,其中75％的颈内动脉(ICA)得以保护。早期结果示,3％短暂性缺血,4％永久性神经功能障碍,其中1例死亡。而远期脑缺血、瘘复发和假性动脉瘤发生的危险度不详。分析87例88个CCFs可脱性球囊栓塞的远期结果,以了解这一方法     

外伤性颈内动脉海绵窦瘘的血管内栓塞治疗:20例回顾性病例系列研究

目的 评价血管内栓塞治疗外伤性颈内动脉海绵窦瘘(traumatic carotid-cavernousfistula,TCCF)的临床效果.方法 20例TCCF患者,10例采用可脱性球囊栓塞,4例采用可脱性球囊结合弹簧圈栓塞,2例采用单纯弹簧圈栓塞,3例采用弹簧圈结合Onyx胶栓塞,1例采用覆膜支架置入术.其中,有2例因球囊早泄而再次栓塞.结果 20例患者一次性栓塞成功18例,二次栓塞成功2例.颈内动脉通畅率100％,未发生手术相关并发症.结论 血管内栓塞是治疗TCCF的一种简单、安全和疗效可靠的方法.     

介入疗法治疗外伤性颈内动脉-海绵窦瘘(附52例报告)

外伤性颈内动脉 -海绵窦瘘 (Carotid cavernousfistular,CCF)是指外伤致海绵窦段的颈内动脉壁或其分支发生破裂 ,导致与海绵窦之间形成的异常动静脉通路。 2 0世纪 70年代以前 CCF是外科治疗的一个难题 ,1 972年 Serbinenko首次应用可脱性球囊栓塞治疗 CCF获得成功[1 ] ,随着先进 DSA机的出现 ,以及优质的导管、球囊、弹簧圈等栓塞材料的应用 ,血管内栓塞治疗 CCF已成为本病的首选治疗方法 [2 ] 。 1 989～ 2 0 0 3年 ,我们对 52例 CCF患者采用血管内栓塞治疗 ,取得满意效果。现报告如下。1　临床资料本组男 37例 ,女 1 5例 ;年龄 1…     

覆膜支架治疗外伤性颈动脉海绵窦瘘二例报道并文献复习

尽管应用可脱性球囊可治愈大部分外伤性颈动脉海绵窦瘘（carotid cavernous fistula,CCF）,但仍有少数病例治疗相当困难.对于一些可脱性球囊难以治愈的病例,既要去除病灶,又要保持颈内动脉的通畅则更加困难.首都医科大学宣武医院神经外科采用覆膜支架血管成形术,成功治疗了2例瘘口较小的TCCF,现报道如下.     

25例颈动脉海绵窦瘘的血管内治疗

目的 总结微弹簧圈、Onyx胶以及覆膜支架治疗颈动脉海绵窦瘘(carotid cavernous fistula,CCT)的初步体会.方法 25例CCF患者,其中外伤性22例,自发性3例;14例瘘口位于右侧颈内动脉(internal carotid artery,ICA)海绵窦段,11例位于左侧ICA海绵窦段.按Barrow分型:A型22例,C型2例,D型1例.18例单纯应用可脱弹簧圈治疗,1例应用可脱弹簧圈结合Onyx栓塞治疗,2例单纯应用Onyx栓塞治疗,4例应用覆膜支架治疗.结果 所有病例术后颅内杂音立即消失,术后造影见瘘口完全闭塞,1～20 d后临床症状消失,无死亡以及手术相关性并发症.弹簧圈治疗患者ICA通畅占12/18,4例带膜支架治疗患者ICA均通畅.2例Onyx治疗患者ICA通畅,1例可脱弹簧圈结合Onyx治疗患者ICA通畅.1例经弹簧圈治疗的外伤性CCF 1个月后复发,经再次弹簧圈治愈.其余患者随访6～24个月未见临床症状复发,6例术后获得脑血管造影随访,CCF均未见复发.结论 弹簧罔、Onyx 和覆膜支架血管内治疗是一种安全和有用的CCF治疗方法.     

Percutaneous transluminal angioplasty as an adjunct to treat the carotid-cavernous fistula

We report a case of the direct carotid-cavernous fistula (CCF) with high-grade stenosis of the internal carotid artery (ICA) and treatment via the transarterial route after percutaneous transluminal angioplasty (PTA). A 46-year-old man was found to have a CCF after a motorcycle accident. Transarterial embolization was attempted, but it failed due to stenosis of the left cervical ICA. After the procedure of PTA for dilatation of the stenotic ICA, the fistula was successfully obliterated by detachable balloon subsequently. There were no complications or recurrence of the fistula at the three-year clinical follow up.     

Catheter closure of coronary artery fistulas

Coronary artery fistulas are rare and vary widely in their morphological appearance and presentation. This paper presents experience of catheter closure of coronary artery fistulas in 40 patients. Catheter closure was performed with a variety of techniques, including detachable balloons, stainless steel coils, controlled-release coils, controlled-release patent ductus arteriosus (PDA) coils, and Amplatzer PDA plug. The vast majority of the fistulas were occluded with coils and in particular, controlled-release coils. Successful occlusion of the fistula was achieved in 39 (97%) of 40 patients. In one patient, the detachable balloon deflated prematurely and the patient underwent elective surgery. One 4-month-old infant died approximately 6 hours after the procedure. Immediate occlusion of the coronary artery fistula occurred in 33 (82%) of patients and late occlusion in 4 patients. Thus overall, total occlusion was achieved in 37 (97%) of 39 patients. The main complication was embolization of the occlusion device, which occurred in 6 (17%) of cases. In one of these cases, a detachable balloon deflated prematurely, and in five patients, coils embolized and were retrieved. In one of the patients, all six coils embolized 24 hours after the procedure but were retrieved, and further coils were implanted successfully. Controlled-release coils have made an important contribution to the technique of catheter closure of coronary artery fistulas. Catheter closure of these fistulas is an acceptable alternative to the standard surgical treatment.     

Selective coronary artery fistula embolization with hystoacryl during percutaneous coronary angioplasty

The percutaneous approach to coronary artery fistula (CAF) is diverse; coils, detachable balloons and double-umbrella devices can be used. Selective embolization with hystoacryl is a novel technique that has been successfully used in patients with intracerebral arteriovenous fistulae. Hystoacryl is a resin, which on contact with the bloodstream immediately solidifies, causing complete luminal obliteration of the fistulous pathway. In the present report, we describe two cases of CAF draining into the pulmonary artery. These two cases were successfully treated with hystoacryl embolization of the fistulous pathway, during the same procedure of coronary angioplasty for localized atherosclerotic lesions in major epicardial vessels.     

Hypopituitarism caused by carotid cavernous fistula

Here we report a 79-year-old woman who presented with a 7-day history of headache, nausea, vomiting, and was found to have proptosis and ptosis. Laboratory findings showed hyponatremia, hypocortisolism, secondary hypothyroidism and low follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. CT angiography (CTA) showed a vascular lesion in sella causing a mass affect on the pituitary gland which proved to be a carotid cavernous fistula (CCF) by conventional angiography. The lesion was subsequently treated with coil placement and patient's hyponatremia was successfully treated with corticosteroid and thyroid hormone replacement. Though rare, CCF should be considered in the differential diagnosis of sellar lesions. Also, in patients with CCF hyponatremia, hypotension or signs of hypothyroidism should warrant a work-up for pituitary function.     

Cholecystocolonic fistula: facts and myths. A review of the 231 published cases

Background

Cholecystocolonic fistula (CCF) is the second most common cholecystoenteric fistula and is often discovered intraoperatively, resulting in a challenging situation for the surgeon, who is forced to switch to a complex procedure, often in old, unfit patients. Management of this uncommon but possible finding is still ill defined.

Methods

An extensive review of 160 articles published from 1950 to 2006 concerning 231 cases of CCF was performed.

Results

CCF is mostly an affliction of women in their sixth to seventh decades and is rarely diagnosed preoperatively. Chronic diarrhea is the key symptom in nonemergency patients, but, in one-fourth of cases, CCF presents with an acute onset, mostly biliary ileus. In one-fourth of patients, a second hepatobiliary abnormality is present, including gallbladder cancer in 2% of cases. In uncomplicated cases, diverting colostomy is not performed anymore, and laparoscopy treatment has been described in specialized centers. Symptomatic treatment of concomitant biliary ileus (without treating CCF) is a feasible option. Resolution of colonic biliary ileus by interventional endoscopy is reported.

Conclusion

CCF should be considered in differential diagnosis of diarrhea, especially in old, female patients. A possible second hepatobiliary abnormality should be always investigated. Extemporaneous frozen section should be performed if gallbladder cancer is suspected. Depending on clinical presentation, different treatments for CCF are indicated, ranging from minimally invasive procedures to extensive resection.     

覆膜支架治疗颅内动脉疾病的临床分析

目的探讨覆膜支架在治疗颅内动脉疾病中应用的可行性和适应证。方法使用糙膜支架行病变隔绝术治疗20例患者。根据靶血管的直径和病变的长度，选择覆膜支架的直径和长度。共治疗椎动脉颅内段动脉瘤5例、颅底以上颈内动脉动脉瘤7例，经蝶手术致颈内动脉破损1例，外伤件颈内动脉动脉瘤3例、外伤性颈内动脉海绵窦瘘3例、颈内动脉海绵窦段狭窄伴自发性颈内动脉海绵窦瘘1例。共使用覆膜支架21枚，裸支架与覆膜支架联合使用3例。结果一次性成功放置支架17例，病变即刻消失14例，术后复查消失3例，操作失败3例。短暂性轻偏瘫1例。结论合理使用覆膜支架是治疗部分颅内动脉病变的良好手段，但覆膜支架的应用也有一定的局限性。