合并颅内外动脉异常交通支的颌面部血管畸形的诊治

目的 分析颌面部血管畸形合并颅内外异常交通支的临床资料及特点，为避免脑异位栓塞提供参考。方法 分析对有适应证的120例颌面部血管畸形行患侧颈内、外动脉和椎动脉造影及供瘤动脉栓塞治疗中14例合并颅内外动脉异常交通支患者的临床资料。结果 14例中9例栓塞前，5例栓塞后发现颅内外存在异常交通支，占同期血管内栓塞治疗的病例的11.7％（14／120）,其中枕椎动脉交通11例，咽升－椎动脉交通1例，颌内－眼动脉交通2例。14例中蔓状血管瘤（动静脉畸形）9例，海绵状血管瘤（静脉畸形）4例，葡萄酒色斑并巨唇症1例。结论 当颌面部血管畸形合并颅内外异常交通支时，在数字减影血管造影术(digital subtr action angiography,DSA) 优良的血管造影下，充分超选择插管，采用3F微导管在设法避开异常交通支后，进行供瘤动脉栓塞治疗是安全可行的。     

颌面部蔓状血管瘤的血管内介入治疗

目的 研究颌面部蔓状血管瘤的血管内介入治疗价值.方法 回顾性分析24例颌面部蔓状血管瘤的选择性动脉造影与分次完全填充栓塞的治疗资料.结果 24例颌面部蔓状血管瘤患者经分次完全填充栓塞治疗后治愈者8例,显效12例,有效4例,总有效率为100%.10例行手术切除,术中出血明显减少.所有病例术中及术后均无严重并发症发生.结论 经选择性血管造影明确诊断后行栓塞治疗是颌面部蔓状血管瘤安全有效的治疗手段.     

头颈部血管性疾病的介入诊治

目的评价介入诊疗技术在头颈部血管性疾病中的诊断和治疗价值。方法对采用Seldinger技术动脉插管造影、栓塞进行诊断和治疗的鼻咽纤维血管瘤、外伤性颈内动脉海绵窦瘘、头面部血管瘤、难治性鼻出血等32例进行回顾性分析。结果32例数字减影血管造影(DSA)成像中,除6例血管瘤无显影,2例腭、颈部肿块明确为颈内动脉瘤而瘤体与颈内动脉共壁无法栓塞之外,其余24例均成功进行了栓塞治疗。栓塞作为单一治疗方式的11例中,颈内动脉海绵窦瘘1例、难治性鼻出血5例、蔓状血管瘤4例均一次栓塞治愈,1例Ⅲ期鼻咽纤维血管瘤姑息性栓塞控制了症状;栓塞辅以手术治疗的13例,术中出血量明显减少,其中6例鼻咽纤维血管瘤,术中平均出血量为260ml,7例血管瘤术中平均出血量为150ml。结论DSA造影在头颈部血管性病变中能显示供血动脉、异常交通支、动静脉瘘等清晰的动态图像,指导临床治疗方法的选择;血管内栓塞治疗对颈外动脉系统的难治性鼻出血、颈内动脉海绵窦瘘、部分血管瘤显示出良好的治疗效果;对血运丰富的肿瘤,术前栓塞可显著减少术中出血,大大提高手术的安全性。     

头颈部血管性疾病的介入诊治

目的:评价介入诊疗技术在头颈部血管性疾病中的诊断和治疗价值。方法:对采用Seldinger技术动脉插管造影、栓塞进行诊断和治疗的鼻咽纤维血管瘤、外伤性颈内动脉海绵窦瘘、头面部血管瘤、难治性鼻出血等32例进行回顾性分析。结果:32例数字减影血管造影 (DSA)成像中,除6例血管瘤无显影,2例腭、颈部肿块明确为颈内动脉瘤而瘤体与颈内动脉共壁无法栓塞之外,其余24例均成功进行了栓塞治疗。栓塞作为单一治疗方式的11例中,颈内动脉海绵窦瘘1 例、难治性鼻出血5例、蔓状血管瘤4例均一次栓塞治愈,1例Ⅲ期鼻咽纤维血管瘤姑息性栓塞控制了症状;栓塞辅以手术治疗的13 例,术中出血量明显减少,其中6例鼻咽纤维血管瘤,术中平均出血量为260ml,7例血管瘤术中平均出血量为150ml。结论:DSA造影在头颈部血管性病变中能显示供血动脉、异常交通支、动静脉瘘等清晰的动态图像,指导临床治疗方法的选择;血管内栓塞治疗对颈外动脉系统的难治性鼻出血、颈内动脉海绵窦瘘、部分血管瘤显示出良好的治疗效果;对血运丰富的肿瘤,术前栓塞可显著减少术中出血, 大大提高手术的安全性。图2参5     

创伤性迟发性鼻出血与假性动脉瘤关系的临床研究

目的 探讨创伤性迟发性鼻出血的诊断和治疗方法,并提出创伤性颌面部中小动脉假性动脉瘤性鼻出血的概念.方法 回顾性总结、分析了1990年3月-2005年3月期间山东省立医院耳鼻咽喉科收治的表现为创伤性迟发性鼻出血并接受数字减影血管造影检查和治疗的53例患者的有关资料.结果 该53例患者中,颈内动脉假性动脉瘤8例,其中7例行血管栓塞治疗,6例痊愈,1例死亡;另1例未行栓塞,在行建立侧支循环功能训练时出血死亡;颈内动脉海绵窦瘘20例,均使用可脱性球囊栓塞成功;颌面部中小动脉出血25例,21例为上颌动脉和或面动脉分支出血,使用明胶海绵颗粒结合弹簧圈行血管栓塞治疗,4例筛前动脉出血者行筛前动脉结扎术.随访6～72个月,中位随访时间为5年.除1例上颌动脉栓塞者再次鼻出血外,其余患者随访期间均未再出血,未发生严重并发症.结论 颈内动脉假性动脉瘤、颈内动脉海绵窦瘘、颌面部中小动脉假性动脉瘤性鼻出血是导致创伤性迟发性鼻出血主要原因,采用数字减影血管造影技术明确诊断并进行血管内栓塞或动脉结扎是治疗该类疾病的有效办法.     

颌面部高流量血管畸形直接穿刺线圈栓塞

先天性高流量动静脉畸形（AVM）和动静脉疾（AVF）在上领部、下颌部和耳前区少见。它常因鼻出血、耳出血或拔牙时引起致命性大出血。AVM或AVF用经导管栓塞已成为手术或姑息治疗的一种有效而重要的辅助手段。邻近颌面部血管性病变供血血管（即颈外动脉或颌内动脉）结扎常不成功，此由于供血血管的侧支补充，或主要血管径路已闭塞而不能经导管再作栓塞。有的在反复施行硬化剂或血管粘合剂检塞血管，若再出血则妨碍再用经导管栓塞操作。该作者应用金属线图对欲栓塞的血管直接穿刺后，送入线因达到阻断血管获得成功。报告AVMI例和AVFZ例…     

颈部及面部病变的血管内介入治疗

目的探讨颈面部病变的血管内介入治疗价值。方法回顾性分析152例颈面部病变患者的血管内介入治疗资料。结果82例颈、椎动脉狭窄闭塞性病变者,81例一次性成功地置入了血管内支架,1例患者因严重狭窄与扭曲,导丝无法通过而改行外科手术治疗。对42例颈、面部肿瘤性病变成功地进行了靶血管双重栓塞治疗,对16例颈面部蔓状血管瘤成功地进行了靶血管分次完全填充栓塞治疗,7例颈面部假性动脉瘤和5例颈髓血管畸形者均获得了成功的常规介入治疗。结论超选择插管后行血管内介入治疗是颈面部病变安全有效的治疗手段。     

动脉栓塞与平阳霉素注射治疗鼻面部血管瘤4例报告

探讨应用介入栓塞加平阳霉素注射治疗鼻面部血管瘤的临床疗效。方法采用线段和弹簧栓介绍栓塞面动脉、颌内动脉和颞浅动脉、瘤内注射平阳霉素。结果：随访１年,４例患者肿块消失,无异常的血管搏动,结论应用介入栓塞和 霉素瘤内注射治疗鼻面部血管瘤安全,疗铲满意。     

介入栓塞术在头面部血管瘤治疗中的应用

目的:探讨颌面部血管瘤数字减影成像(digital subtraction angiography,DSA)显影下血管栓塞术适应证及临床疗效。方法:选择19例头颈部血管瘤患者行DSA血管成像术,21次成功地对颈外动脉分支进行了介入栓塞治疗:A组11例,为永久性栓塞,其中5例术后再用硬化剂行瘤体封闭;B组共8例,为术前栓塞,以减少手术中出血。结果:DSA血管成像19例清晰显示动脉期像。术后16例随访6个月～5年:A组栓塞后瘤体明显缩小,局部打硬化剂者疗效更佳;B组中,4例鼻咽纤维血管瘤术中出血平均仅150ml,2例蔓状血管瘤术中出血平均200ml。2例患者出现短期轻度复视和偏瘫。结论:DSA下动脉栓塞治疗对蔓状血管瘤,有明确责任动脉的海绵状血管瘤显示良好的临床疗效,栓塞后辅助硬化剂注射可减少复发,对鼻咽纤维血管瘤等的术前栓塞可明显减少术中出血。     

治疗颈-面部血管发育异常时结扎颈外动脉的危险性

对颈-面部的血管病变,作为治疗或为制止紧急出血,常行颈外动脉结扎术(ligation of the external carotid,LCE)。如仅行LCE而不即时完整地切除血管病变,则在数日内颈外动脉及其分支就可从其众多的侧支循环中获得原来的血流量,其中,由脑部动脉或眶部动脉发展而来的侧支循环及其血流改道,将有一定危险,甚至发展为血管瘤。作者们根据6年来200多例颈-面部血管瘤的动脉造影和栓塞法,及其中13例LCE的经验,认为除非是非常必要,应绝对放弃LCE,而目前栓塞法是最有效的方法。     

Maxillofacial vascular malformation associated with abnormal communication between external carotid and cranial arteries]

OBJECTIVE: To introduce the clinical characteristics of maxillofacial vascular malformation with abnormal communication between external carotid and cranial arteries. METHODS: One hundred and twenty patients with maxillofacial vascular malformations had been studied by arteriography of internal and external carotid, and vertebral arteries before embolization of tumor supplying artery. Cases found to have communications between extra- and intra-cranial arteries were analyzed. RESULTS: Fourteen patients (11.67%, 14/120) were found to have abnormal communications between external carotid and cranial arteries. Among them, 11 patients demonstrated communications between occipital and vertebral arteries, 1 patient showed ascending pharyngeal artery and vertebral artery communication, and 2 patients showed maxillary artery-ophthalmic artery communication. CONCLUSION: Embolization of tumor supplying artery is a safe and practical method for the treatment of maxillofacial vascular malformation when done under digital subtraction angiography and superselective catheterization to avoid the abnormal communicant branches.     

Cervical vascular and upper airway asymmetry in velo-cardio-facial syndrome: Correlation of nasopharyngoscopy with MRA

Purpose

Velo-cardio-facial syndrome (VCFS), the most common genetic syndrome causing cleft palate, is associated with internal carotid and vertebral artery anomalies, as well as upper airway asymmetry. Medially displaced internal carotid arteries, often immediately submucosal, present a risk of vascular injury during pharyngeal flap surgery for velopharyngeal insufficiency (VPI). We evaluate the frequency and spectrum of cervical vascular anomalies in a large cohort of VCFS patients correlating MRA with nasopharyngolaryngoscopy in detecting at risk carotid arteries. Furthermore, we assess the relationship with respect to laterality between cervical vascular patterns and the asymmetric abnormalities of these subjects’ upper airways.

Methods

Cervical MRAs of 86 subjects with VCFS and 50 control subjects were independently reviewed by three neuroradiologists. The course of the internal carotid and vertebral arteries was identified within the pharyngeal soft tissues. Medial deviation, level of bifurcation, dominance, anomalous origin, and vessel tortuosity were recorded. Nasopharyngoscopy examinations were available for retrospective review in 43 patients and were assessed for palatal and posterior pharyngeal wall symmetry, true vocal cord motion and size, and for the presence or absence of carotid pulsations. The endoscopic findings were compared with MRA results.

Results

Of the 86 subjects, 80 (93%) had one or more vascular anomalies. 42 subjects (49%) were found to have medial deviation of at least one internal carotid artery. In 24 subjects (28%) the anomalous internal carotid artery was directly submucosal; four of these were bilateral (5% of the total sample, 17% of those with a submucosal internal carotid). Other carotid anomalies included low carotid bifurcation (44 subjects or 51%), anomalous origin of the right common carotid (32 cases, or 37%), and two cases of internal carotid agenesis/hypoplasia. Vertebral artery anomalies included vessel tortuosity (34 cases, or 40%), hypoplasia (10 cases, or 12%), looping (4 cases, or 5%), and one case of a double left vertebral artery. Though patients in our study showed an asymmetric distribution of vascular anomalies, no association was found between the laterality of palatal motion, pharyngeal fullness, or laryngeal movement and structure with ipsilateral vertebral or carotid artery anomalies. Of the 33 pulsatile carotid arteries visualized at nasopharyngoscopy, only nine were found to be submucosal on MRA. In contrast, 11 submucosal carotid arteries confirmed at MRA demonstrated no visible pulsations. Positive and negative predictive values of pulsative arteries seen endoscopically for MRA confirmation of a submucosal carotid course was 27% and 79% respectively.

Conclusions

Carotid and vertebral artery anomalies are common in VCFS including marked medial deviation of the internal carotid artery in close proximity to the donor site for pharyngeal flap surgery. Lack of correlation between laterality of vascular anomalies and upper airway structural asymmetry in VCFS does not support the hypothesis that palatal, pharyngeal, and laryngeal anomalies are due to secondary developmental sequences caused by in utero vascular insufficiency. The presence or absence of carotid pulsations seen by nasopharyngoscopy does not correlate with the carotid arterial depth identified on MRA. Furthermore, identification of the relative medial-lateral retropharyngeal position of a submucosal carotid affords the opportunity to modify the surgical approach. These findings further support the routine use of pre-operative neck MRA in VCFS patients in surgical planning.     

选择性血管内栓塞治疗难治性鼻出血的临床分析

目的：了解选择性血管内栓塞治疗难治性鼻出血的疗效及影响疗效的因素。方法：23例难治性鼻出血患者在颈动脉数字减影血管造影(DSA)的基础上行选择性颌内动脉末梢病变血管内栓塞，其中5例同时栓塞面动脉。结果：DSA证实23例患者均存在颌内动脉末梢发育不良或畸形，15例伴有出血征象，6例并面动脉形态异常。治愈22例，其中l例24h内复发鼻出血者证实有新侧支供血，经补加栓塞后出血停止，治愈率为95．6％。l例治疗失败，与栓塞前去除鼻腔填塞物有关，且不能除外有面动脉出血。结论：难治性鼻出血与颌内动脉发育不良及畸形有关，选择性血管内栓塞治疗能收到迅速而满意的疗效。治疗失败与潜在侧支开放或面动脉出血有关，过早去除鼻腔填塞物也是影响栓塞疗效的因素。     

三叉神经颅内段的血液供应

目的 本研究通过对三叉神经(颅内段)血供的观察，为与三叉神经相关的疾病的手术及术中止血提供临床解剖学资料。方法 在手术显微镜下对20侧成人尸头标本进行三叉神经颅内段的显微解剖研究。观察其血供。结果 三叉神经(颅内段)的血供来源广泛，其中三叉神经根的血供主要来源于小脑前下动脉(占70％)、脑桥上外侧动脉(占55％)、小脑上动脉(占45％)、脑桥下外侧动脉(15％)；三叉神经节的血供主要来自海绵窦下外侧动脉(占75％)，当下外侧动脉不发达或缺如时，则主要来自脑膜垂体于的外侧支(占30％)；眼神经近段血供主要来自海绵窦下外侧动脉后支(占55％)，远段主要来自海绵窦下外侧动脉前支(占75％)；上颌神经近段血供主要来自海绵窦下外侧动脉，远段来自上颌动脉的分支翼腭动脉和颞深中动脉、脑膜中动脉；下颌神经主要由颈外动脉的分支脑膜中动脉和颞深中动脉供血。结论 三叉神经根的滋养动脉主要来源于基底动脉的分支，三叉神经节和其三大分支可同时接受颈内、颈外动脉分支供血，在涉及三叉神经的手术时，既要防止损伤其滋养动脉，又要考虑病灶血供来源的复杂性。     

颈动脉体瘤诊断与外科治疗的探讨(附30例报告)

目的 :探讨进一步提高颈动脉体瘤诊断符合率和手术成功率的手段。方法 :采用血管造影术 (或数字减影血管造影术 ,即 DSA)明确术前诊断。 3 0例颈动脉体瘤中 ,行血管外膜下剥离 12例 ,外膜下剥离并颈外动脉切除 8例 ,肿瘤并颈内、外动脉切除 10例。结果 :4例失访 ,1例术后 2年死于交通意外 ,2 5例随诊 5个月～ 10年未见肿瘤复发 ,无一例手术死亡或脑血管并发症。结论 :DSA是颈动脉体瘤最具权威性的诊断方法 ,DSA或 (和 )经颅多普勒在颈动脉切除术中起决定性作用 ,准确的术前评估、正确地选择术式和操作步骤是手术成功的关键。     

Doppler ultrasonography can be useful to determine the etiology of idiopathic sudden sensorineural hearing loss

Objective

This study aims to evaluate clinical features of both carotid and vertebral arteries in the idiopathic sudden sensorineural hearing loss (ISSNHL) patients and healthy individuals to contribute additional knowledge on vascular compromise theory.

颈部大血管损伤的诊治

目的探讨颈部大血管损伤的诊断和治疗方法,以提高诊疗水平。方法对1974～1999年诊治的18例颈部大血管损伤进行回顾性分析。结果受伤血管颈总动脉7条,颈外动脉4条,颈内动脉2条,锁骨下动脉1条,颈内静脉4条。损伤类型切割伤8例,撕裂伤5例,离断伤2例,炎性损伤2例,肿瘤侵犯损伤1例。15例根据颈部伤口活动性或喷射性大出血作出诊断,2例血肿经彩色多普勒超声波检查明确诊断,1例术中探查得到诊断。手术采用血管缝合修补8条,颈外、颈总动脉结扎各3条,锁骨下动脉结扎1条,颈外动脉代替颈内动脉血管重建1条,颈内静脉结扎及填塞止血各1条。术后痊愈14例,肢体轻度偏瘫1例,锁骨下动脉经结扎后上肢坏死截肢1例,死亡2例,死亡率为11.1%。结论活动性或喷射性大出血是诊断的主要依据,治疗应根据损伤血管选择合理的手术方案。     

颈部大血管损伤的诊治

目的 探讨颈部大血管损伤的诊断和治疗方法,以提高诊疗水平。方法 对1974－1999年诊治的18例颈部大血管损伤进行回顾性分析。结果 受伤血管：颈总动脉7例,颈外动脉4条,颈内动脉2条,锁骨下动脉1条,颈内静脉4条。损伤类型：切割伤8例,撕裂伤5例, 离断伤2例,炎性损伤2例,肿瘤侵犯损伤1例。15例根据颈部伤口活动性或喷射性大出血作出诊断,2例血肿经彩色多普勒超声波检查明确诊断,1例术中探查得到诊断。手术采用血管缝合修补8条,颈外、颈总动脉结扎各3条,锁骨下动脉结扎1条,颈外动脉代替颈内动脉血管重建1条,颈内静脉结扎及堵塞止血各1条。术后痊愈14例,肢体轻度偏瘫1例,锁骨下动脉经结扎后上肢坏死截肢1例,死亡2例,死亡率为11．1％。结论 活动性或喷射性大出血是诊断的主要依据,治疗应根据损伤血管选择合理的手术方案。     

Vascular supply of recurrent juvenile angiofibroma after external carotid artery ligation

A case of recurrent juvenile angiofibroma after the operation with external carotid artery ligation is described. Arteriography demonstrated significant collateral circulation to the tumour from the internal carotid and vertebral arteries.     

A case of congenital agenesis of the common carotid artery associated with an ectopic parathyroid adenoma mimicking a carotid body tumor

Ectopic parathyroid adenomas can be encountered during four gland explorations, but nearly 80% of adenomas are localized with ultrasound and sestamibi imaging. Ectopic adenomas are thought to arise from abnormal migration during development. As a cervical congenital anomaly, common carotid artery agenesis is an extremely rare anomaly characterized by separate origins of the internal and external carotid arteries directly from the aortic arch. Here we present a case of a 75 year old man with primary hyperparathyroidism who was found to have congenital agenesis of the common carotid artery associated with an ectopic parathyroid adenoma within the parapharyngeal space, which mimicked a carotid body tumor based on location and imaging. The successful identification and resection of the ectopic parathyroid adenoma presented here demonstrate the importance of preoperative imaging studies to allow appropriate operative planning as well as the utility of intraoperative parathyroid hormone assay in predicting cure during surgery.