前颅窝底硬脑膜动静脉瘘的经动脉入路治疗

目的评价经动脉入路栓塞前颅窝底硬脑膜动静脉瘘(DAVF)的临床疗效。方法分析6例有症状前颅窝底硬脑膜动静脉瘘(DAVFs)经动脉血管内治疗技术和结果。结果 6例经动脉入路插入导管用Onyx-18胶栓塞。本组病例在治疗过程中都能接近瘘口处并栓塞动静脉分流区域。最后血管造影显示DAVF完全闭塞。治疗后没有观察到相关后遗症,6例均进行临床随访,GOS评分均为5。6例获脑血管造影随访,均未见瘘口显影。结论经动脉入路栓塞前颅窝底DAVFs是可行的。     

静脉窦球囊保护介入栓塞治疗侧窦区硬脑膜动静脉瘘

目的探讨静脉窦球囊保护下介入栓塞治疗侧窦区硬脑膜动静脉瘘的应用。方法回顾性分析12例侧窦区硬脑膜动静脉瘘病人的临床资料。术中在静脉窦球囊保护下,经动脉途径采用Onyx-18介入栓塞治疗。结果静脉窦保护良好11例,静脉窦壁有Onyx-18胶附着1例。完全栓塞9例,部分栓塞3例。术后小脑出血1例,小脑水肿伴脑疝1例,癫疒间发作1例,认知功能下降2例。随访11例,时间6～8个月,静脉窦通畅10例,闭塞1例。临床预后良好10例,认知功能减退1例。术后植物状态1例(未随访)。结论静脉窦球囊保护下介入栓塞治疗侧窦区硬脑膜动静脉瘘是一种安全有效的方法,有利于保持静脉窦通畅。     

海绵窦区硬脑膜动静脉瘘介入治疗的疗效分析

目的 探讨弹簧圈+Onyx-18胶栓塞治疗海绵窦区硬脑膜动静脉瘘（CS-DAVF）的疗效。方法 回顾性分析2012年1月至2020年1月介入治疗的42例CS-DAVF的临床资料。先采用弹簧圈栓塞以降低血流速度,再用Onyx-18胶栓塞;经静脉入路32例,经动脉入路5例,动静脉联合入路5例。结果 术后即刻DSA显示瘘口均消失,完全栓塞31例（73.8%）,次全栓塞11例（26.2%）。无手术死亡病例。术后6~12个月,42例DSA随访,1例复发;临床症状消失34例（81.0%）,3例视力无明显改善,5例术后伴有外展神经麻痹。结论 采用弹簧圈联合Onyx-18胶介入栓塞治疗CS-DAVF的效果良好。可根据病人的具体情况选择静脉途经、动脉途径或动静脉联合途径。     

海绵窦区硬脑膜动静脉瘘的介入治疗分析

目的 探讨海绵窦区硬脑膜动静脉瘘的介入治疗方法及其疗效。方法 回顾性分析2013年1月至2023年1月介入治疗的21例海绵窦区硬膜动静脉瘘的临床资料。结果 经股静脉-岩下窦途径16例，经颈外动脉入路4例，经动静脉联合入路1例；采用弹簧圈联合Onyx-18胶栓塞17例，单纯应用弹簧圈1例，单用Onyx-18胶3例；术后即刻造影显示瘘口完全闭塞18例，次全闭塞3例。术后随访3～12个月，临床治愈17例，好转4例。15例复查造影未见瘘口复发。结论 根据海绵窦区硬脑膜动静瘘血管构筑特征，采用个体化的血管内治疗方案，可以获得满意的临床疗效。     

经不同路径应用Onyx-18胶栓塞治疗前颅窝底硬脑膜动静脉瘘的疗效分析

目的初步探讨经不同路径应用Onyx-18胶栓塞治疗前颅窝底硬脑膜动静脉瘘(ACF-DAVF)的安全性和有效性。方法回顾性分析南京大学医学院附属鼓楼医院神经外科2018年11月至2022年1月应用Onyx-18胶栓塞治疗的11例ACF-DAVF患者的临床资料, 所有患者术前数字减影血管造影(DSA)显示ACF-DAVF均为Cognard Ⅳ型, 根据其供血动脉、引流静脉情况个体化选择经眼动脉、脑膜中动脉镰前支、脑膜中动脉镰前支联合眼动脉及经静脉4种路径进行栓塞治疗, 术后即刻行DSA复查并行Class分级评估栓塞效果;分析经不同路径栓塞的治疗效果、并发症及随访结果。结果 11例患者共进行11次栓塞, 均顺利完成。其中, 经眼动脉入路栓塞5例, Class分级Ⅰ级4例、Ⅱ级1例, 1例术后出现迟发性出血;经脑膜中动脉镰前支入路栓塞3例, Class分级均为Ⅰ级, 无围手术期并发症发生;经脑膜中动脉镰前支联合眼动脉入路栓塞1例, Class分级为Ⅰ级, 术后出现左侧眼眶区疼痛, 2 d后症状消失;经静脉入路栓塞2例, Class分级均为Ⅰ级, 无围手术期并发症发生。11例患者的随访时间为(1...     

Onyx结合微弹簧圈经静脉入路治疗硬脑膜动-静脉瘘

研究背景采取单纯微弹簧圈栓塞供血动脉姑息治疗硬脑膜动静脉瘘的方法,在栓塞血管巢近端供血动脉后,可出现新的供血动脉并可能改变静脉引流途径,从而增加颅内出血风险。闭塞引流静脉是一种十分有效的治疗方法,且经静脉途径闭塞引流静脉成功率较高,本研究尝试经静脉入路注射液体栓塞剂Onyx结合微弹簧圈栓塞治疗硬脑膜动静脉瘘,并探讨其疗效。方法经静脉入路栓塞治疗12例硬脑膜动静脉瘘患者(海绵窦区8例、横窦乙状窦区4例),通过脑血管造影检查及临床随访评价疗效。结果术后即刻全脑血管造影检查瘘口完全闭塞者11例、瘘口处血流速度明显减慢者1例。随访3个月至3年,临床症状完全消失者11例、明显缓解者1例。结论应用液体栓塞剂Onyx结合微弹簧圈经静脉入路栓塞治疗硬脑膜动静脉瘘安全有效。     

经眼动脉入路栓塞前颅窝底硬脑膜动静脉瘘的效果

目的探讨经眼动脉途径栓塞颅前窝底硬脑膜动静脉瘘(DAVF)的临床疗效和安全性。方法回顾性分析2010年4月至2017年6月经眼动脉入路使用Onyx18胶栓塞治疗的13例颅前窝底DAVF的临床资料。结果术后即刻造影显示,完全栓塞9例,部分栓塞4例。术后2例发生视物模糊。术后6个月随访造影显示,13例均完全栓塞。结论经眼动脉入路使用Onyx18胶栓塞颅前窝底DAVF是一种有效的治疗方法。     

Onyx胶栓塞治疗硬脑膜动静脉瘘的初步体会

目的 总结应用Onyx胶栓塞治疗硬脑膜动静脉瘘的初步结果 及经验.方法 采用Onyx胶经血管内栓塞治疗18例影像学证实的硬脑膜动静脉瘘.对所有患者的临床特征及血管内治疗过程进行同顾性分析.结果 15例采用动脉入路、1例采用动静脉联合入路、2例采用静脉入路进行栓塞治疗.13例患者经栓塞后瘘口完全闭塞,3例大部分柃塞,2例部分栓塞,死亡1例.17例患者随访3～24个月,症状完全消失或无加重.造影显示病变1例复发.结论 Onyx胶是血管内栓塞治疗硬脑膜动静脉瘘的理想材料,通过动脉入路对大多数患者能较好的弥散并栓塞瘘口,短期疗效满意.对于动脉入路难以到达瘘口而静脉窦通畅者,可行动静脉入路或静脉入路进行.其长期效果有待进一步的随访评价.     

球囊辅助介入栓塞硬脑膜动静脉瘘

目的 应用球囊辅助Onyx胶介入栓塞硬脑膜动静脉瘘,分析球囊辅助栓塞的意义和效果.方法 回顾性分析6例球囊辅助Onyx胶介入栓塞的硬脑膜动静脉瘘患者,总结临床表现,血管造影特点,血管内治疗方案及临床疗效.结果 6例患者中4例表现为皮层静脉返流.在球囊辅助下,5例经动脉入路栓塞,1例经静脉入路栓塞.4例患者球囊用于保护颈内动脉,1例用于保护椎动脉,1例用于脑膜中动脉防止Onyx胶返流并降低瘘口流速.术后血管造影示4例完全栓塞,2例部分栓塞.1例出现栓塞相关的暂时性面神经麻痹.结论 应用球囊辅助Onyx胶介入栓塞治疗颈内颈外动脉共同供血的硬脑膜动静脉瘘,能够有效地保护颅内动脉.在供血动脉中充盈球囊能够有效防止Onyx胶返流并降低瘘口流速.     

Onyx和／或弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘

目的探讨经不同入路应用Onyx、弹簧圈或二者联合栓塞治疗海绵窦区硬脑膜动静脉瘘的疗效。方法回顾性分析21例经DSA证实为海绵窦区硬脑膜动静脉瘘患者的临床资料。21例患者中,15例经岩下窦入路栓塞,2例经面静脉或颞浅静脉一眼静脉人路栓塞,4例经动脉入路栓塞;单纯使用Onyx栓塞11例,单纯用弹簧圈栓塞3例,用弹簧圈联合Onyx栓塞7例,其中2例注入Onyx过程中使用封堵球囊保护颈内动脉。结果栓塞术后即刻造影显示瘘口完全闭塞17例,大部分闭塞4例。栓塞术后所有颅内杂音均消失。术后出现同侧眼睑下垂加重2例,动眼神经麻痹1例,外展神经麻痹2例,3月后均改善。16例患者随访3～62个月,平均随访28个月;6例经DSA随访未见复发,10例电话或门诊随访症状改善。结论使用Onyx、弹簧圈或二者联合进行栓塞治疗海绵窦区硬脑膜动静脉瘘,静脉入路为首选,必要时可使用封堵球囊保护供血动脉,可以取得较为满意的疗效。     

Clinical characteristics of dural arteriovenous fistula.

Intracranial dural arteriovenous fistula (DAVF) is an uncommon neurosurgical condition; in particular, it has been infrequently reported in Korea. To understand the general clinical characteristics of DAVFs, the authors reviewed 53 cases and analyzed factors affecting DAVF hemorrhage of and treatment outcome. Since 1980 we have encountered 480 pial and 53 DAVFs, a ratio of 9.1 to 1. The age of these patients ranged from 1 month to 71 years, the most common being in the 6th decade, and females exceeded males by 1.65 to 1. All lesions except three were single, and symptoms were related to location and the venous drainage pattern. The most common location was the cavernous sinus, accounting for about 64% of cases, with the result that the most common clinical symptoms of DAVFs were ocular, namely proptosis and chemosis. The next was tinnitus also found in transverse-sigmoid sinus DAVFs. Intracranial hemorrhage was seen in eight cases,(15%) the primary cause of hemorrhage was retrograde intracranial venous drainage (P=0.017), and one hemorrhage was observed in cases with no intracranial venous drainage. Intracranial hemorrhage was more frequently in transverse-sigmoid than cavernous sinus DAVFs (P=0.049), and this proved to be so even where there was intracranial venous drainage. However, two of 34 patients with cavernous DAVFs became blind in one eye, demonstrating that in such patients, the clinical course could be aggressive. Thirteen patients were treated conservatively. The conservative treatment group was comprised of 13 patients, two of three patients with transverse-sigmoid sinus DAVF expired, and 7 of 10 with cavernous sinus DAVF experienced a clinical improvement or cure. Surgical excision was performed in only two patients. A total of 39 patients underwent embolization; clinical cure was achieved in 13, improvement of symptoms in 12, an unchanged or aggravated result occurred in 9, one died, and four were lost to follow up. During intervention, there was one hemorrhagic complication, owing to obstruction of the venous outflow with embolic materials.In this study, the most common location of DAVFs was the cavernous sinus. The cortical venous drainage remains the primary determinant of intracranial hemorrhage. Common indications for treatment include hemorrhage and neurological deficit. Endovascular treatment is preferred in the majority of cases except tentorial DAVF. The goal of embolization in cavernous DAVF is the alleviation of symptoms, not angiographic cure. But transverse-sigmoid sinus DAVF with venous restriction and leptomeningeal drainage should be treated aggressively.     

Endovascular treatment for dural arteriovenous fistulas at the jugular foramen

We report the technique and results of the endovascular treatment of jugular foramen dural arteriovenous fistulas (DAVFs) in 4 (3 men and 1 women, mean age 50.75 years) symptomatic patients. The jugular foramen DAVFs accounted for 5.9% of intracranial DAVFs. Three patients presented with pulsatile tinnitus and 1 patient presented with intracranial hemorrhage. Angiography demonstrated an AV fistula at the jugular foramen, mostly arising from the middle meningeal, ascending pharyngeal and vertebral arteries with direct drainage to the internal jugular vein. All patients underwent transarterial embolization using Onyx-18. Complete shunt obliteration was achieved in 3 patients; and shunt reduction, in 1 patient, who was cured with additional surgery. Our study suggests that in jugular foramen DAVF transarterial embolization with Onyx should be considered when access is available.     

ONYX 18栓塞天幕区硬脑膜动静脉瘘的临床研究(附四例报道)

目的 探讨经动脉途径使用ONYX 18栓塞治疗天幕区硬脑膜动静脉瘘的临床方法 及疗效. 方法 回顾性分析宣武医院神经外科自2008年3月至7月收治的4例天幕区硬脑膜动静脉瘘患者的临床资料(包括病史、查体、影像学检查、手术记录、随访情况等),其中急性蛛网膜下腔出血1例,进行性神经功能障碍3例;瘘口位于天幕顶2例,天幕左侧1例,天幕后份1例;硬脑膜动静脉瘘分型为Ⅱb型2例,Ⅲ型1例.Ⅳ型1例.4例患者均行经动脉途径使用ONYX 18栓塞治疗(ONYx注入量分别为1.5 mL、3.5 mL、9 mL、12 mL),1例合并阻塞性脑积水者在栓塞后行脑室腹腔分流术. 结果 本组患者术后完全栓塞3例,1例残余枕动脉少许供血瘘口,血流明显减慢.4例患者门诊或电话随访3个月,原有症状均无出现. 结论 在微导管到达合适的位置时,通过正确的注射ONYX 18,通过单一供血动脉,可以将整个天幕区硬脑膜动静脉瘘的瘘口、静脉端及所有供血动脉填塞.达到完全治愈.该方法 治疗高危硬脑膜动静脉瘘安全有效.     

Treatment outcomes of intracranial dural arteriovenous fistulas of the transverse and sigmoid sinuses from a single institute in Asia

Intracranial dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses (TSS) are rare in Asian populations. This study sought to evaluate the treatment outcomes of intracranial TSS DAVFs at a single Asian institute. Between 1989 and 2007, 122 patients presented to the Seoul National University Hospital with intracranial DAVFs; we performed a retrospective analysis of the 38 patients (31.1%) with TSS DAVFs. The common clinical presentations were headache (44.7%), tinnitus (39.5%), and intracranial hemorrhage (26.3%), and 71.1% had Borden type II or III lesions. Two patients were conservatively managed, two underwent surgery, and 34 were treated endovascularly with transarterial embolization (TAE), transvenous embolization (TVE), or both. The complete occlusion rate immediately after treatment was 50%. Of the 31 patients (81.6%) who underwent follow-up angiography, initial complete occlusion was achieved in 51.6%, and, at the last follow-up, the complete occlusion rate was 64.5%, with the surgery and TVE groups achieving 100% occlusion. The clinical cure rate was 34.2%, and 86.8% of patients had a favorable clinical outcome. However, all patients in both the surgery and TVE groups achieved a favorable clinical outcome. Four (26.7%) of 15 lesions with initially partial embolization showed delayed occlusion. Five patients (13.2%) exhibited clinical or angiographic signs of recurrence, and five patients had permanent complications. TSS DAVFs were less common than cavernous sinus DAVFs, unlike in Western countries, but the angiographic and clinical characteristics of TSS DAVFs were similar to those in Western countries. TSS DAVFs were successfully managed with different modalities, but both surgery and TVE were superior to conservative management or TAE.     

侧窦区硬脑膜动静脉瘘的血管内介入治疗

目的本文报道我科对连续收治的10例侧窦区(横窦和乙状窦)硬脑膜动静脉瘘(DAVF)行超选择性动脉内栓塞的初步经验。方法所有病人先进行脑血管造影,确诊为侧窦区DAVF后立即对供血动脉行超选择性造影术并用NBCA胶或PVA颗粒进行栓塞。结果10位病人进行16次栓塞治疗(有6例行2次),共对23根供血动脉进行了栓塞。其中8例采用NBCA胶,另2例采用PVA颗粒进行栓塞。8例栓塞后获得解剖学和临床治愈,另2例虽获临床治愈,但造影中仍可见少量病灶残留。4例伴有搏动性耳鸣和杂音者在首次栓塞后其症状和体征消失,其中1例搏动性耳鸣在第一次部分栓塞后2个月复发,但在第二次栓塞后消失。无一例病人在栓塞后出现并发症。结论超选择性动脉内栓塞治疗对于某些类型的侧窦区DAVF是一个安全、有效和微侵袭的治疗方法。     

Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization

Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which has high risk of intracranial hemorrhage. We present two cases of tentorial DAVF which were successfully treated with single trial of transarterial embolization using Onyx. We briefly reviewed the types of the tentorial DAVF and strategies of treatment.     

椎动脉颅内段动脉瘤的治疗方法分析

目的探讨椎动脉颅内段动脉瘤治疗方法的选择。方法 21例椎动脉颅内段动脉瘤患者中7例采用手术治疗(其中采用开颅手术动脉瘤直接夹闭4例,搭桥术3例),14例经血管内治疗。结果预后良好17例,差4例,无死亡病例。结论血管内介入治疗及外科手术治疗能使绝大部分椎动脉颅内段动脉瘤得以治愈,但应遵循个体化治疗方案方能取得满意治疗效果。     

硬脑膜动静脉瘘的治疗分析（附15例报告）

目的探讨硬脑膜动静脉瘘的治疗方法及其效果。方法回顾性分析2010年9月到2012年9月收治的15例硬脑膜动静脉瘘病人的临床资料。手术治疗4例,血管内治疗7例,伽玛刀治疗2例,保守治疗2例。结果手术治疗的4例患者均恢复良好。血管内治疗的7例患者中,5例术后即刻行造影显示硬脑膜动静脉瘘消失,未发生并发症;另2例栓塞后有少量残留,通过压迫供血的颈总动脉治愈。伽玛刀治疗2例,随访1年症状好转。保守治疗的2例患者,通过压迫供血的颈总动脉,其中1例成功治愈,另1例好转。15例患者出院后随访6～30个月,7例血管内治疗患者中2例复发,1例再次栓塞后治愈,1例通过压迫供血的颈总动脉及伽玛刀治疗后好转;随访期间15例患者均无神经功能缺失表现。结论硬脑膜动静脉瘘应针对其部位及类型,选择相应的治疗方法;血管内治疗安全、有效,是其首选方法。