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。     

硬脑膜动静脉瘘MSCTA诊断的临床价值

目的探讨多层螺旋CT血管造影(MSCTA)在硬脑膜动静脉瘘诊断中的临床价值。方法回顾性分析6例硬脑膜动静脉瘘MSCT影像表现,6例患者均行DSA检查,CTA采用(VR)、最大密度投影法(MIP)等方法进行图像重组,多角度显示脑血管树,观察供血动脉、引流静脉、静脉窦瘘口的情况,与DSA进行对比,观察其一致性。结果本组硬脑膜动静脉瘘2例发生在横窦-乙状窦区(均为Ⅰ型),2例位于海绵窦区(分别为Ⅰ、Ⅱ型),1例位于额叶颅底区(Ⅲ型),1例自两侧顶部引流至上矢状窦(Ⅱ型)。对于引流静脉和静脉窦等细节显示,CTA表现与DSA和手术所见高度一致。结论在硬脑膜动静脉瘘的诊断中,根据其发病部位及分型,以及有无并发症等征象,MSCTA对于临床治疗方案的选择具有重要意义。     

静脉支架成形治疗矢状窦复杂性硬脑膜动静脉瘘

目的 探讨通过静脉支架植入改善硬脑膜动静脉瘘引流，治疗伴引流静脉狭窄的硬脑膜动静脉瘘的可行性及疗效。方法 1例上矢状窦，左侧横窦及颈静脉球区的复杂性硬脑膜动静脉瘘患者，伴右侧横窦闭塞，左侧颈静脉严重狭窄达80％，矢状窦扩张，将支架植入狭窄静脉，改善静脉引流。结果 成功植入静脉支架，残余狭窄约30％，症状明显改善，头痛逐渐消失，行走不稳消失，视力较前明显改善。6个月后复查脑血管造影显示颈静脉支架位置形态好，无支架内狭窄，上矢状窦、横窦及乙状窦瘘口较前无明显变化。结论 静脉支架植入改善硬脑膜动静脉瘘引流，治疗伴引流静脉狭窄的硬脑膜动静脉瘘是可行的，其近期疗效满意，长期疗效有待进一步随访观察。     

血管内介入治疗硬脑膜动静脉瘘的新进展

硬脑膜动静脉瘘是较常见的颅内血管畸形,目前尚无理想治疗方案,且易并发脑出血。数字减影血管造影(DSA)技术可清楚显示瘘口发生部位、供血动脉及引流静脉,是诊断硬脑膜动静脉瘘的金标准。本研究着重介绍新型材料Onyx在血管内栓塞治疗中的应用、疗效与注意事项,主要探讨血管内介入治疗硬脑膜动静脉瘘的研究新进展。     

静脉窦开通治疗硬脑膜动静脉瘘伴静脉窦闭塞3例

目的 探讨静脉窦开通治疗硬脑膜动静脉瘘(DAVF)伴静脉窦闭塞的效果.方法 回顾性分析2009年9月至2015年5月收治的3例DAVF伴静脉窦闭塞患者临床资料.结果 1例患者经单纯开通静脉窦后治愈DAVF,2例患者经机械性开通联合球囊扩张恢复静脉窦主干通畅后症状明显好转;均未出现介入治疗并发症.结论 部分DAVF伴静脉窦闭塞患者静脉窦开通后正常脑静脉回流通畅,横窦、乙状窦周围DAVF瘘口能达到彻底、永久闭合.静脉窦开通恢复有效血流动力学是治疗DAVF伴静脉窦闭塞的有效方法.     

经静脉入路海绵窦内液体胶联合弹簧圈栓塞海绵窦区硬脑膜动静脉瘘

目的探讨应用经静脉入路联合液体胶和弹簧圈介入栓塞海绵窦区硬脑膜动静脉瘘的方法和策略。方法回顾性分析应用经静脉入路联合液体胶和弹簧圈栓塞治疗的8例海绵窦区硬脑膜动静脉瘘患者,包括瘘口的血管构筑学、治疗方法和疗效。结果所有患者均采用经静脉入路液体胶联合弹簧圈栓塞,其中经面静脉-眼上静脉入路1例,经岩下窦入路7例。8例均临床治愈,患者术后即刻造影提示瘘口完全消失。除术后早期头痛外无其他介入相关并发症。临床随访3个月～3年,患者无临床症状复发。结论经静脉入路应用液体胶联合弹簧圈介入栓塞对于海绵窦区硬脑膜动静脉瘘是安全、有效且经济的治疗方法 。     

颅内静脉窦血栓致硬脑膜动静脉瘘并双侧丘脑病变1例

该文报道了1例颅内静脉窦血栓致硬脑膜动静脉瘘并双侧丘脑病变的患者。女, 76岁, 首发症状为右侧额叶出血导致的左侧肢体麻木无力, MR诊断为静脉窦血栓, 静脉性梗死。后续演变为硬脑膜动静脉瘘, 造成双侧丘脑病变, 经栓塞治疗后好转。     

肢体和颅面部血管畸形的血管造影诊断及介入治疗

目的 探讨肢体和颅面部血管畸形的血管造影诊断及介入治疗的临床价值.资料与方法 56例肢体和颅面部血管畸形患者,颅面部14例,上肢18例,下肢24例.先行血管造影,了解病变部位、累及范围、供血动脉、引流静脉及侧支循环情况.然后行栓塞治疗,超选择插管至病变供血动脉内,根据病变性质、造影表现、插管的具体位置及治疗目的 ,选择不同种类、大小的栓塞剂及栓塞方法.对四肢近端局限性动静脉瘘患者置入带膜支架封堵瘘口.结果 56例患者通过选择性动脉造影均明确诊断,其中44例表现为动静脉畸形,供血动脉与引流静脉之间有明显迂曲扩张畸形血管团;12例表现为动静脉瘘.23例行介人治疗,其中21例栓塞后临床症状和体征均有不同程度的缓解,表现为局部包块缩小,血管杂音减轻或消失,心脏功能改善等,2例带膜支架置入后血管杂音消失.随访4～48个月,除2例臀部血管畸形患者栓塞后1年左右又出现临床症状而接受相应治疗外,其余患者均未出现明显临床症状.结论 经导管动脉造影是肢体和颅面部血管畸形的可靠诊断方法;介入治疗血管畸形创伤小、安全、有效,并发症少.     

脊髓血管畸形的影像学诊断和血管内栓塞治疗

复杂的脊髓血管解剖，包括脊髓多来源的供养动脉和多去路的引流静脉，导致脊髓血管畸形的影像学诊断变得困难。脊髓血管畸形大致分为三类：髓内动静脉畸形、髓周动静脉瘘和硬脊膜动静脉瘘。髓内动静脉畸形的畸形团位于或大部分位于脊髓实质内。其供血动脉为脊髓前动脉及其分支，脊髓后动脉也经常同时参与供血。其引流静脉常同时向脊髓前、后静脉引流。最典型的临床症状为畸形团破裂出血。其治疗以分次血管内栓塞治疗为主。手术切除弊大于利，一般不采用。治疗的目的是改善症状而非解剖治愈。髓周动静脉瘘是脊髓外的软膜动脉与静脉的直接交通，常常是脊髓前动脉或脊髓后动脉与相应的静脉直接沟通。主要临床症状亦多为出血，亦可源于脊髓缺血或水肿。治疗方法和原则类似髓内动静脉畸形，但流速缓慢的位于圆锥和终丝部位的髓周动静脉瘘多手术切除。硬脊膜动静脉瘘几乎占所有脊髓血管畸形的80%。男女比例7:1,40岁以上多发。其瘘口位于硬脊膜内和硬脊膜内、外层之间，常靠近椎间孔的神经根，是根动脉的硬脊硬支与根髓静脉之间的直接交通。主要临床症状源于脊髓静脉高压引起的脊髓水肿和坏死。应用稀胶栓塞治疗成功率可达90%。胶一定要在瘘口和引流静脉起始端形成良好的铸型方能避免复发。手术夹闭瘘口简单，效果好，但创伤较大。     

非Galen静脉脑动静脉瘘的诊断和治疗

目的：对１９７９年至１９９５年治疗的１１例非Ｇａｌｅｎ静脉的脑动静脉瘘（ＡＶＦ）的诊断标准及治疗原则进行探讨。材料与方法：本组１１例，男４例，女７例。年龄１岁１０个月至３５岁，平均１２岁。占位症状４例，癫痫３例，出血５例。１例以球囊栓塞失败后行手术夹闭供血动脉；８例以丙烯酸酯胶（ＩＢＣＡ或ＮＢＣＡ）栓塞治疗，其中１例经３次栓塞缩小静脉球后手术切除残留的动静脉畸形（ＡＶＭ）；２例以弹簧圈栓塞瘘口。结果：动静脉瘘解剖治愈８例，恢复良好。８例中的６例于术后１０天至５个月行脑血管造影复查，未见复发；植物生存状态１例；死亡２例。结论：本病为一组先天性脑血管畸形，表现为脑内单支或多支动脉直接与静脉沟通，瘘口处静脉呈动脉瘤样扩张，其间无畸形血管团，静脉扩张引流入静脉窦。血管内栓塞治疗闭塞瘘口可取得良好疗效。     

经眼上静脉介入治疗海绵窦区硬脑膜动静脉瘘

目的 探讨眶上内侧缘切开穿刺眼上静脉介入栓塞海绵窦区硬脑膜动静脉瘘(AVF)的方法和疗效.方法 眶上内侧缘切开穿刺眼上静脉使用微弹簧圈介入栓塞海绵窦区硬脑膜AVF 16例.结果 所有患者均临床治愈,1例虽将海绵窦致密填塞,但仍有少量翼丛引流,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.2例术后出现轻度复视,后自行恢复,无一例出现永久性介入相关并发症.临床随访5个月到6年,患者均无临床症状复发.结论 眶上内侧缘切开穿刺眼上静脉入路介入栓塞是海绵窦区硬脑膜动静瘘治疗安全有效的方法 之一.     

Embolization of dural cavernous fistulas via superior ophthalmic vein approach.

PURPOSETo present the results of our treatment of dural cavernous sinus fistulas with surgical exposure of the superior ophthalmic vein (SOV), retrograde venous catheterization, and coil embolization of the cavernous sinus.METHODSTwelve patients with dural cavernous sinus fistulas were treated via a retrograde transvenous SOV approach in our hospital during a 3-year period. All patients had been referred by ophthalmologists because of secondary glaucoma and decreased visual acuity. Angiography showed preferential venous drainage of the dural cavernous sinus fistulas to an enlarged ipsilateral SOV. A total of 13 SOV exposures were performed, one patient with bilateral fistulas required bilateral treatment. The vein was surgically exposed by an ophthalmologist and then catheterized. Platinum coils were delivered through a microcatheter at the fistula site and into the root of the SOV, until there was complete angiographic closure.RESULTSCatheterization and embolization were successful in 12 of the 13 patients, with complete angiographic occlusion of the fistula. Two patients with bilateral fistulas had transient worsening of symptoms on the contralateral side. Three patients required follow-up angiography. No early complications occurred, and late complications were minor in two cases. All patients except one with long-standing symptoms recovered premorbid visual acuity. At follow-up, 11 (92%) of the 12 embolized fistulas remained occluded.CONCLUSIONSRetrograde catheterization of the SOV and embolization of the cavernous sinus with coils is a direct, safe, and efficient way to occlude dural cavernous sinus fistulas.     

Transvenous embolization of dural fistulas involving the cavernous sinus

Because of the risks associated with arterial embolization of cavernous dural fistulas, we have sought an alternative method to promote fistula closure. Thirteen patients underwent transvenous embolization as a treatment for symptomatic cavernous dural fistulas. All procedures were performed from a femoral vein access through the inferior petrosal sinus or basilar plexus. In five patients the inferior petrosal sinus was not angiographically demonstrable; however, embolization was still possible through this route in two patients. The embolic agents used were detachable balloons in one patient, coils alone in five, coils and liquid adhesives in four, coils plus silk sutures in one, silk sutures alone in one, and liquid adhesives alone in one. Nine patients had follow-up angiograms, which showed complete obliteration of the fistulas and complete resolution of related symptoms. One patient had complete resolution of clinical symptoms but refused follow-up angiography. Another patient had 50% decrease in fistula flow on the follow-up angiogram and improvement in clinical symptoms. Two patients had complete fistula obliteration after embolization and progressive improvement in symptoms but follow-up angiograms had not been obtained. Follow-ups ranged from 1 to 97 months (mean, 15 months). Two complications were related to this treatment. An embolic stroke followed transient placement of a balloon in the internal carotid in one patient, and a second patient developed transient visual loss when the venous outflow pathways were occluded before fistula closure. The fistula was immediately closed with complete recovery of vision. With recent advances in microcatheter and embolic agent technology, transvenous closure of cavernous dural fistulas is now possible.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dural arteriovenous fistulas involving the inferior petrosal sinus: angiographic findings in six patients

We report the angiographic findings from six patients with intracranial dural arteriovenous fistulas of the inferior petrosal sinus and describe the clinical presentation, vascular anatomy, and embolization techniques used in the treatment of this disorder. Dural arteriovenous fistulas at this site are rare; of 105 patients diagnosed with this abnormality, only six had lesions involving the inferior petrosal sinus. The patients included three men and three women, ranging in age from 41 to 75 years. Patients presented with bruit, proptosis, abducens palsy, or loss of vision, and symptoms were present for up to 1 year prior to diagnosis. These presentations were similar to cavernous sinus arteriovenous fistulas. The arterial supply in all cases was from branches of the external carotid artery and in three cases from the meningohypophyseal trunk of the internal carotid artery. Venous drainage in four patients was via the cavernous sinus to the superior ophthalmic vein. The remaining two patients had drainage primarily to the jugular bulb. In four patients treatment was performed by introducing wire coils into the fistula from the transvenous route. This approach could be used even though the inferior petrosal sinus was thrombosed. One patient, treated early in the series, had only transarterial embolization with both liquid adhesives and particulate embolic agents. One patient had an asymptomatic fistula that was not treated. All patients were cured, as evidenced both angiographically and clinically during the follow-up period. Three patients experienced complications from angiography and treatment: two had transverse sinus thrombosis and one had a transient ischemic attack.     

Occlusion of arteriovenous malformations of the cavernous sinus via the superior ophthalmic vein

The treatment of five patients with dural arteriovenous malformations (AVMs) of the cavernous sinus via the superior ophthalmic vein (SOV) is reported. The procedure was performed by transcutaneous puncture of the SOV under the guidance of real-time digital subtraction angiography. Complete resolution of the ocular symptoms was achieved in all cases. Angiograms after embolization showed complete obliteration of the malformation in four cases and partial obliteration in one. This method can cure dural AVMs of the cavernous sinus, with preservation of blood flow in the internal carotid artery. It is particularly indicated when the SOV is enlarged and when (1) dural AVMs of the cavernous sinus are fed by small branches of the internal carotid artery or direct carotid cavernous fistulas with small tears; (2) dural AVMs of the cavernous sinus are fed by multiple branches from both the internal and external carotid arteries, one or both sides; or (3) dural AVMs of the cavernous sinus or direct carotid cavernous fistulas recur after trapping of the internal carotid artery. Transcutaneous puncture and catheterization of the SOV was performed safely with the aid of digital subtraction angiography. The SOV approach was able to treat the fistula with preservation of the internal carotid artery.     

Computed tomographic and digital subtraction angiography evaluation of ophthalmic-ethmoidal artery dural arteriovenous fistula

Ophthalmic-ethmoidal dural arteriovenous fistula (DAVFs) is a rare type of dural arteriovenous fistulas and usually presenting with spontaneous subarachnoid hemorrhage, subdural hemorrhage or ocular symptoms. We present a case of a 59-year old gentleman presenting with acute headache, vomiting and generalized weakness. CT study of the brain revealed a large left frontal hematoma and abnormal aneurysmal sac with dilated cortical vein, communicating with the superior sagittal sinus. Conventional angiography confirmed diagnosis of ruptured ophthalmic-ethmoidal DAVF, resulting in a frontal intra-axial hemorrhage. Anterior fossa DAVFs are extremely rare, difficult to diagnose and treat. CT angiography is initial method of diagnosis, but digital substruction angiography remains the gold standard of confirming dural fistulas.     

Management of vascular perforations that occur during neurointerventional procedures

This article describes a number of treatment strategies for the management of perforations that occur during neurointerventional procedures. During the past 5 years, we have performed over 1200 endovascular procedures to treat vascular disorders involving the brain and spinal cord (400 cerebral arteriovenous malformations, 230 tumors, 197 carotid cavernous fistulas, 183 aneurysms, 130 dural fistulas, 80 spinal arteriovenous malformations, 18 vein of Galen aneurysms, and 20 cases of vasospasm). Fifteen patients (1.1%) sustained a vascular perforation as a direct result of these procedures. Among these 15 patients, indications for endovascular treatment were six symptomatic arteriovenous malformations, two spinal cord arteriovenous malformations, two cavernous sinus dural fistulas, one transverse sinus fistula, one case of vasospasm following subarachnoid hemorrhage, one direct carotid cavernous fistula, one vein of Galen malformation, and one ruptured basilar artery aneurysm. The vascular perforations were grouped into three probable mechanisms: mechanical perforation of a normal vessel (six patients), mechanical disruption of a dysplastic vessel or aneurysm (five patients), and fluid overinjection (four patients). Treatment of the perforations included immediate reversal of anticoagulants (12 patients) and direct closure of the perforation site with coils (five patients). In addition, closure of the intravascular compartment adjacent to the perforation was achieved with coils (six patients), liquid adhesives (four patients), balloons (two patients), or particles (two patients). In two patients a detachable balloon was placed transiently across the perforation site for several minutes, deflated, and removed when no further extravasation was noted. Five patients were started on anticonvulsant therapy, two of whom have had a new onset seizure related to the perforation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Interventional radiology in the treatment of high-flow renal arteriovenous fistulas. Report of two cases

PURPOSE: To describe the morphological and haemodynamic characteristics of high-flow idiopathic renal arteriovenous fistulas and the radiological treatment techniques. MATERIALS AND METHODS: Two cases of idiopathic renal arteriovenous fistula were treated with transcatheter embolization. In the first case, the anomalous arteriovenous communication was embolized with acrylic glue through the afferent artery while the efferent vein was temporarily occluded with a balloon catheter using the "stop flow" technique. In the second case, the fistula was occluded from the arterial side using Gianturco coils and the "free flow" technique. RESULTS: In both cases post-procedural angiography demonstrated occlusion of the fistula. A color-Doppler US examination 6 months later showed the regularization of flow parameters in the renal artery and vein. Angiographic follow-up showed occlusion of the arteriovenous fistula, regularization of the renal artery calibre and normal renal parenchymal flow. CONCLUSIONS: Embolization is the best treatment for rare, high-flow, renal arteriovenous fistulas. The "stop flow" technique with acrylic glue is fast and economical. The "free flow" technique with coils is more expensive and complex, but just as effective.     

Transvenous embolization of a dural arteriovenous fistula of the cavernous sinus through the contralateral pterygoid plexus

We report a new transvenous endovascular route for treatment of dural arteriovenous fistulas of the cavernous sinus. The cavernous sinus was approached from the contralateral pterygoid plexus and embolization of a dural fistula was performed successfully with Guglielmi detachable coils. Received: 16 June 1997 Accepted: 6 August 1997