海绵窦填塞术治疗外伤性颈内动脉海绵窦瘘

报告1例外伤性颈内动脉海绵窦瘘采用海绵窦填塞术治疗获得成功。在常温常压下应用甘露醇、地塞米松后暂时阻断颈内动脉血流,切开海绵窦Parkinson’s三角,填入栓塞物封闭瘘口。此手术操作不甚复杂,且较安全,既能完全封闭瘘口,又能维持颈内动脉血流,是治疗外伤性颈内动脉海绵窦瘘的有效方法之一。     

颈内动脉海绵窦瘘1例

患者,女,52岁。2003年3月以“左眼睑浮肿伴眼红、眼球突出渐加重一月”就诊。眼科检查：ODV5．1,OSV4．8;右眼前后节(-)。左眼睑浮肿,球结膜血管充血怒张,以角膜缘为中心呈放射状排列,角膜光泽,KP(-),前房深浅正常,Tyn(-)。瞳孔直径3mm(右2mm),对光反射灵敏;眼底：视盘色淡红,边界稍模糊,视网膜静脉迂曲、轻度扩张。黄斑部色暗。     

颈内动脉海绵窦瘘患者的整体护理

颈内动脉海绵窦瘘是颈内动脉海绵段或其分支的破裂所形成的动脉瘘。临床上有眼球突出搏动，颅内杂音。又干尔为搏动性突眼。症状可于损伤后当时发生，但多数是在伤后2个门之内，也有可迟达半年以上者。     

颈内动脉海绵窦瘘13例法医学鉴定体会

目的:分析外伤性和自发性颈内动脉海绵窦瘘的临床特点,探讨法医学鉴定方法。方法:回顾性分析13例颈内动脉海绵窦瘘的法医学鉴定过程和结果。结果:10例鉴定为外伤性颈内动脉海绵窦瘘,3例为自发性颈内动脉海绵窦瘘。鉴定结论均被法院采纳,且被双方当事人接受。结论:仔细的询问病史,结合影像学资料可鉴别外伤性和自发性颈内动脉海绵窦瘘。     

外伤性颈内动脉海绵窦瘘的CT诊断

目的：探讨CT检查对外伤性颈内动脉海绵窦瘘的诊断价值。方法：收集了我院5例外伤性颈内动脉海绵窦瘘临床及影像学表现。结果：5例病例全部在CT检查中得到确诊。结论：CT检查是诊断外伤性颈内动脉海绵寞瘘的实用、准确方法。     

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。     

外伤性颈内动脉海绵窦瘘介入治疗的护理

目的:总结外伤性颈内动脉海绵窦瘘介入治疗的护理经验。方法:回顾分析经球囊栓塞术的10例外伤性颈内动脉海绵窦瘘患者临床护理资料,总结护理经验。结果:10例患者均一次性栓塞治疗成功,术后无并发症发生。结论:对患者术前、术后进行严密观察与精心护理,可以提高栓塞治疗疗效,降低并发症的发生。     

血管内栓塞治疗外伤性颈内动脉海绵窦瘘7例

探讨颈内动脉海绵窦瘘(CCF)血管内栓塞治疗的效果.方法:7例均经DSA全脑血管造影明确瘘口部位,采用可脱性球囊或电致血凝性可脱性铂金弹簧圈(GDC)进行栓塞.结果:7例中,3例球囊栓塞成功并保持颈内动脉通畅;2例表现为假性动脉瘤,用球囊闭塞患侧颈内动脉;1例因瘘口太小,用GDC填塞海绵窦;另1例两次试放球囊入海绵窦均破裂失败,其中一枚瘪陷球囊滞留于海绵窦,患者不愿闭塞患侧颈内动脉未予进一步治疗,但术后一周临床症状和体征均消失.结论:颈内动脉海绵窦瘘全脑血管造影可明确瘘口部位、大小,首选治疗方法是血管内栓塞治疗.     

Diagnosis and endovascular treatment of spontaneous direct carotid-cavernous fistula

Background Spontaneous direct carotid-cavernous fistula （CCF） is relatively rare and few reports have been found in the literature. The aim of this paper was to report the clinical characteristics, imaging findings and curative effect of endovascular treatment for patients with spontaneous direct CCF. Methods We retrospectively analyzed the clinical data of nine patients with spontaneous direct CCF admitted between May 2003 and November 2007 and the outcomes.of endovascular treatment. Sudden neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis （n=8）. No patients had a history of head trauma. Cerebral digital subtraction angiography （DSA） was performed on all cases under local anesthesia and seven cases received endovascular treatment. Results In eight patients, internal carotid angiograms recorded during the early arterial phase revealed aneurysms located in the cavernous sinuses, and in one patient, a dilated internal carotid artery （ICA） was seen. Among the nine cases, seven received endovascular treatment via a transarterial approach and complete occlusion of the fistula was obtained with no technique-related complications, one died suddenly before treatment and one gave up treatment. A detachable balloon was used as the embolic material in two cases, a detachable balloon and detachable coil as the embolic material in two cases, balloon-assisted coil embolization in two cases and covered stents were successfully placed in the parent vessel to exclude the aneurysm and fistula from circulation in one case. During a follow-up period of 3-48 months, all treated patients remained asymptomatic except for one patient who suffered from ipsilateral decreased vision. Conclusions Most spontaneous direct CCF may be caused by a ruptured intracavernous aneurysm with direct shunting into the cavernous sinus. Endovascular treatment seems to be a safe and effective method for treating spontaneous direct CCF.     

颈内动脉海绵窦的治疗及其解剖基础

目的探讨颈内动脉海绵窦瘘的治疗 ,着重分析引流静脉与海绵窦的解剖结构之关系。方法回顾性的分析经DSA血管造影确诊的颈内动脉海绵窦瘘 76例 ,观察分析颈内动脉海绵窦瘘的引流静脉的显示情况及其解剖学基础。其中 2 1例行可脱性球囊、微弹簧圈血管内栓塞治疗 ,5例行外科手术。结果 76例均经DSA血管造影作出了准确的诊断。 2 6例经血管内栓塞治疗和外科治疗后症状和体征消失。结论正确认识CCF的引流静脉与海绵窦解剖之关系 ,有助于正确合理的选择CCF的治疗方式。     

双源CT在诊断颈动脉粥样硬化性狭窄病变中的应用

目的 评价双源CT在颈动脉粥样硬化性狭窄病变诊断中的应用价值.方法 对46例患者颈内动脉进行双源CT颈动脉造影,对图像质量进行分级评价,评估其诊断价值.结果 对46例造影患者共276段血管进行评估,显示清晰者为243段(88%),显示较好者为27段(0.1%),显示差者为6段(0.02%).结论 双源CT颈动脉造影在诊...     

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.     

双源CT成像评价冠状动脉病变的临床价值

目的 通过双源CT对冠脉检查与选择性冠状动脉造影的对比分析,探讨DSCT对冠脉病变诊断的意义.方法 55例同期行双源CT冠状动脉血管成像及选择性冠状动脉血管造影(CAG)检查的患者,分析比较DSCTCA的敏感性、特异性及准确度.结果 (1)DSCT冠状动脉造影按病例计算.诊断冠心病的敏感度、特异度、阳性和阴性预测值、准确度分别为97.7%、72.6%、93.5%、88.9%和92.7%;按病变血管计算,其敏感度、特异度、阳性和阴性预测值、准确度分别为94.9%、95.8%、92.5%、97.1%、95.5%;按可评价节段计算,检测节段病变总的敏感度、特异度、阳性和阴性预测值、准确度分别为88.2%、96.9%、90.5%、96.1%、94.7%.(2)DSCT造影与选择性冠脉造影比较对冠心病的诊断的差别无统计学意义;对诊断各支血管的敏感度、特异度、阳性和阴性预测值、准确度的差别无统计学意义.结论 双源CT对冠心病的诊断准确度接近选择性冠状动脉造影.在冠状动脉疾病的筛查方面,DSCTA在一定程度上可替代CAG.     

创伤性颈动脉海绵窦瘘的血管内栓塞治疗

目的 探讨创伤性颈动脉海绵窦瘘(TCCF)的治疗方法、栓塞技术要点及随访意义。方法 对119例TCCF病人共行128次栓塞。其中,股动脉入路112例,股静脉入路5例,经眼上静脉入路2例;以球囊栓塞瘘口101例,以微弹簧圈栓塞13例,球囊并用弹簧圈2例,干冻硬脑膜3例。术后3月~10年随访110例,其中行影像学复查29例。结果 111例1次栓塞成功,8例于第1次栓塞后球囊泄漏复发,经再次栓塞治愈,总治愈率100%。颈内动脉通畅率90.8%(108/119),无严重并发症,随访显示疗效可靠。结论 TCCF一般经股动脉入路用可脱性球囊栓塞瘘口,小瘘口TCCF选择微弹簧圈栓塞;若颈内动脉结扎或闭塞,可经静脉入路栓塞瘘口。一般情况下海绵窦瘘均表现为良性过程,应力争解剖治愈,不可轻易牺牲颈内动脉。正确选择栓塞途径及栓塞材料是手术成功的关键。     

颈内动脉海绵窦瘘的DSA表现及其解剖基础

目的探讨颈内动脉海绵窦瘘的DSA表现,着重分析引流静脉与海绵窦的解剖结构。方法回顾性的分析经DSA血管造影确诊的颈内动脉海绵窦瘘76例,观察分析颈内动脉海绵窦瘘的引流静脉的显示情况及其解剖学基础。结果76例均经DSA血管造影作出了准确的诊断。经眼上静脉引流为主者72例(占94.7%);经岩上、下窦引流者18例;经基底静脉引流者5例;经皮层静脉引流者15例;经海绵间窦向对侧海绵窦引流者8例。眼上静脉为颈内动脉海绵窦瘘的主要引流静脉。结论正确认识CCF的引流静脉与海绵窦的解剖结构的关系,有助于进一步加深对引流静脉与CCF临床及DSA表现的关系的认识。