静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘临床分析

目的综合性的比较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[1](CSDAVF)与可脱弹簧圈栓塞治疗CSDAVF的优缺点,确定治疗该病的最佳方案。方法回顾性的分析我院随访的20例2007～2011年期间进行静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘的患者,其中经静脉入路联合液体胶和弹簧圈介入栓塞海绵窦区治疗CSDAVF者13例,设为A组;经可脱弹簧圈栓寒治疗CSDAVF者7例设为B组。将两组的治疗结果进行比较分析。结果 A组治愈13例,治疗费用(10.5±3.4)万元,B组治愈5例,2例好转治疗费用(17.1±3.8)万元。结论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为理想的治疗方法。     

经动脉入路Onyx-18栓塞治疗小脑幕区硬脑膜动静脉瘘

目的 探讨经动脉入路应用Onyx-18栓塞小脑幕区硬脑膜动静脉瘘患者的临床治疗经验.方法 分析3例确诊为小脑幕区硬脑膜动静脉瘘的患者,就其临床表现、影像学、治疗策略及结果进行研究并复习相关文献.结果 3例患者均经动脉入路Onyx-18一次性完全栓塞小脑幕硬脑膜动静脉瘘,术后血管造影示病变消失,随访3个月,未再出现颅内出血,1例GOS=5分,2例GOS=4分.结论 选择性脑血管造影是确诊本病的唯一可靠手段,经动脉入路应用非黏附性液体栓塞剂栓塞可以完全栓塞小脑幕硬脑膜动静脉瘘.     

经静脉入路采用Onyx联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘疗效分析

目的探讨经静脉入路Onyx联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘(CDAVF)的疗效。方法 8例CDAVF患者均经静脉入路用Onyx联合弹簧圈栓塞治疗,通过术后造影和临床随访来评估临床效果。结果 8例栓塞后即刻造影检查示瘘口及海绵窦完全闭塞6例,少量残留2例,总有效率为100%,治愈率为75%。栓塞后1例出现动眼神经麻痹,经对症治疗后痊愈,无其他严重并发症发生。术后所有患者均接受临床随访,随访时间3个月至2年,无症状复发及加重者。结论经静脉入路Onyx联合弹簧圈栓塞治疗CDAVF是一种安全及有效的方法。     

硬脑膜动静脉瘘的栓塞治疗：附13例报告

诊断硬脑膜动静脉瘘主要靠动脉造影。报告１３例全脑血管数字减影造影确诊病例进行选择性血管内微导管栓塞治疗情况，效果良好，对病因学、临床特征及影像学表现进行了简短的讨论。栓塞治疗的效果肯定，远期疗效有待进一步随访观察。     

硬脑膜动静脉瘘的治疗

目的：探讨硬脑膜动静脉瘘的病因，分类及治疗。方法：26例均采用超选择插管栓塞，其4例同时行静脉入路静脉窦内栓塞，联合手术2例，X-刀治疗l例。结果：海绵窦区硬膜动静脉瘘者，17例瘘口完全消失，4例栓塞后瘘口有残留，结合颈动脉压迫法后2例瘘口消失。侧窦硬脑膜动静脉瘘者，瘘口完全消失3例，部分消失2例。结论：血管内栓塞治疗硬脑膜动静脉瘘是目前最安全、有效的治疗方法。联合手术或放射治疗等，可大大提高硬脑膜动静脉瘘的临床治疗愈率。     

动脉入路ONYX栓塞治疗海绵窦区硬脑膜动静脉瘘的临床观察

目的探讨采用单纯动脉入路ONYX(医用胶)治疗在海绵窦区硬脑膜海绵窦瘘的意义及栓塞程度对预后的影响。方法回顾性分析2008—2010年我院行动脉入路ONYX治疗的10例患者的手术方式、术中栓塞程度、随访结果及临床意义,10例患者病变均为外伤性,均为择期手术,术中成功弥散ONYX胶,栓塞程度不同,术后随访至1年。结果 3例患者术后残留,行2期治疗,有7例ONYX胶弥散满意,术中造影无残留,分别于随访6个月、1年,3例残留者,瘘口较前分流增多,行2期治疗后,无残留。结论采用经动脉途径予以栓塞治疗的疗效已不容置疑,其优点在于:①可避免经静脉途径栓塞,正常静脉被误栓及栓塞后导致的出血。②术中观察,造影方便,射线量少。③动脉入路操作方便,适用于大多数患者,通过ONYX良好的弥散性能达到完全闭塞瘘口的目的而又不影响血液经静脉窦的正常回流,因此一般可以作为首选。     

Onyx胶栓塞治疗硬脑膜动静脉瘘的疗效分析

目的 探究Onyx胶栓塞30例硬脑膜动静脉瘘（DAVF）的有效性及预后的影响因素.方法 回顾性分析使用Onyx胶栓塞的30例DAVF患者资料.经动脉、静脉、动静脉联合入路栓塞的患者例数分别为25例、2例、3例.结果 28例获解剖学治愈,29例获临床症状治愈,术后随访显示病灶闭塞或残余病灶未增大,未见复发.介入治疗30例DAVF患者的临床疗效与Cognard分级有关,分型越低,治疗容易、预后较好,差异有显著性（χ2=3.96,P=0.042）.结论 Onyx胶栓塞DAVF是有效的,Cognard分级越低,愈后越好.     

海绵窦区硬脑膜动静脉瘘的治疗探讨

目的 探讨海绵窦区硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的治疗方法、效果及预后.方法 25例患者中8例行颈动脉压迫或仅随访观察;17例行血管内栓塞,其中3例经静脉途径栓塞,13例经动脉途径栓塞,其中1例联合使用覆膜支架和Glubran胶治疗,1例经动脉途径治疗后再次接受经静脉途径栓塞治疗.结果 8例行颈动脉压迫或随访观察的患者中有4例症状缓解或消失,其余患者无加重;3例经静脉途径栓塞者均通过同侧或对侧岩下窦入路完全闭塞瘘口;13例经动脉途径栓塞者中4例完全闭塞瘘口,其余患者症状部分缓解;1例患者首次经动脉途径部分栓塞术后症状加重,急诊经眼上静脉穿刺置管完全栓塞.结论 海绵窦区DAVF总体预后良好,可根据患者症状和影像学特征选择恰当的治疗方式,经静脉途径栓塞治愈率高,适宜者应作为首选治疗方法.     

海绵窦区硬脑膜动静脉瘘的栓塞治疗

目的　探讨海绵窦区硬脑膜动静脉瘘的治疗方法。方法　海绵窦区硬脑膜动静脉瘘共 12例 ,经颈外动脉以微粒栓塞 3例 ;以正丁基氰基丙烯酸异丁酯 (NBCA)栓塞 2例 ;经颈外动脉插入海绵窦以NBCA栓塞1例 ;经岩下窦以机械可脱性弹簧圈 (MDS)栓塞 1例 ;经眼上静脉以MDS栓塞 5例。结果　瘘口完全消失 8例 ;瘘口残留 4例 ,其中 2例瘘口残留患者 3个月后症状好转。结论　根据不同的类型 ,经静脉栓塞和经动脉栓塞均可作为海绵窦区硬脑膜动静脉瘘的有效治疗方法     

硬脑膜动静脉瘘的治疗探讨

硬脑膜动静脉瘘 (Ｄｕｒａｌａｒｔｅｒｉｏｖｅｎｏｕｓｆｉｓｔｕｌａｅ ,ＤＡＶＦ)是一类主要累及脑膜及其附属物的血管性疾病 ,其病理特点是颅内外供血动脉直接与颅内静脉窦沟通 ,病灶内血流快 ,正常脑区因低灌流而缺血缺氧 (盗血 ) ,从而引起颅脑一系列病理生理变化。本文报告 8例硬脑膜动静脉瘘的血管内治疗及评价1　临床资料　　一般资料 :男 7,女 1;年龄 2 1～ 5 1岁 ,平均 2 8 3岁。病因 :头部外伤 1例 ;无明显诱因 7例。临床表现 :颅内杂音 8例 ;头皮搏动性包块 3例 ;眼睑静脉怒张伴眼球突出 2例 ;蛛网膜下腔出血 2例 ,牙龈出血 1…     

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via transvenous approach

Cavernoussinusduralarteriovenousfistulas (CSdAVFs)formacomplexcommunicationnetworkbetweenthecavernoussinus (CS)andtheduralbranchesoftheexternalcarotidartery (ECA)and/orinternalcarotidartery (ICA) CSdAVFsusuallybecomesymptomaticspontaneouslyandoccurmostofteninelderlywomen TheclinicalmanifestationsofCSdAVFsdependonthepatternofvenousdrainage Chemosis ,conjunctivalcongestion ,bruit,ophthalmoplegia ,eyelidswelling ,proptosis,diplopia ,andvisualacuityimpairmentmayallresultfromCSdAVFs 1 …     

Update of embolization of intracranial dural arteriovenous fistula

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous communications within the dura locating near a major venous sinus and are supplied by pachymeningeal arteries. DAVFs represent 10–15% of all intracranial arteriovenous malformations. The natural history and clinical manifestations are determined by location of the DAVFs and their angioarchitecture. Aggressive DAVF is usually associated with leptomeningeal venous drains or reflux. It may present with hemorrhagic or nonhemorrhagic stroke. The goal of embolization of DAVFs is total fistula occlusion without interfering with the normal dura–venous drains. Embolization can be performed by transarterial and/or transvenous routes or direct puncture of affected dural sinus. Selection of embolic materials depends on access route and angioarchitecture of the fistula. With the involution of endovascular devices, embolic materials, and high-quality angiography, endovascular embolization of DAVFs has been proved a safe and effective method of treating these complex cerebrovascular lesions.     

血管内栓塞治疗脑动静脉畸形

目的:探讨血管内栓塞治疗脑动静脉畸形(cAVM)的临床意义。方法:应用血管内栓塞治疗cAVM 23例,栓塞剂为NBCA或Onyx,栓塞后2例行显微手术治疗,4例行咖玛刀治疗。结果:畸形血管团完全消失5例,消失80%以上6例,60%~80%7例,60%以下5例。栓塞后1例发生脑出血。结论:血管内栓塞治疗cAVM的方法是安全的,可治愈部分cAVM,对于大型、重要功能区的cAVM,血管内栓塞联合手术或放疗可提高治愈率,降低致残率和病死率。     

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via

Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.     

无球囊导管血管内栓塞治疗脑动静脉畸形

目的 :探讨无球囊导管血管内栓塞治疗脑动静脉畸形 (AVM)的疗效。方法 :采用Seldinger技术及微导管技术 ,将无球囊微导管超选择性插入脑AVM畸形血管团内持续注射NBCA胶行血管内栓塞治疗。结果 :栓塞技术成功率 97.5 %。AVM完全消失 ,解剖治愈 11例 ,AVM畸形血管团大部分消失 ,其减少大于80 %4例 ,减少 5 0 %～ 80 例 ,小于 5 0 %9例。随访 6个月至 5年 ,效果满意。结论 :无球囊导管持续注射栓塞法血管内栓塞治疗脑AVM操作安全 ,疗效确定 ,方法简便 ,具有长期栓塞效果。     

Acute paraplegia following embolization of spinal dural arteriovenous fistula

Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

     

Transarterial Onyx embolization of intracranial dural arteriovenous fistulas: A single center experience

BackgroundTransarterial embolization of intracranial dural arteriovenous fistulas (DAVFs) is usually associated with inadequate embolization. The purpose of this study was to report our experience of transarterial Onyx embolization of intracranial DAVFs with an emphasis on treatment outcome with this new embolic agent in different types of DAVFs.MethodsIn the past 3 years, a total of 14 intracranial DAVFs have been treated by transarterial Onyx embolization. Among these, there were nine males and five females, aged from 30 years to 82 years (mean = 62 years). We retrospectively analyzed the injection volume and time of Onyx embolization as well as outcomes in different types of DAVFs.ResultsThe locations of the DAVFs were sigmoid sinus (n = 6), tentorium (n = 3), sinus confluence (n = 2), transverse–sigmoid sinus (n = 1), sigmoid sinus–jugular bulb (n = 1) and the superior petrous sinus (n = 1). The mean volume and time of Onyx injection were 3.4 mL and 28 minutes, respectively (Cognard type I: 4.9 mL, 40 minutes; type II: 4.5 mL, 34 minutes; type III: 2.2 mL, 21 minutes; type IV: 2 mL, 22 minutes). Total fistula occlusion was achieved in six out of seven patients of type III and type IV DAVFs, and in four out of seven patients of type I and type II DAVFs. Nine patients had total resolution of their symptoms, whereas partial regression occurred in five patients. No significant periprocedural complication was found. Mean clinical follow-up period was 16 months.ConclusionTransarterial Onyx embolization of intracranial DAVFs is safe and effective. This technique is particularly useful in type III and type IV DAVFs with a high cure rate, and lower volume of Onyx as well as a short injection time.     

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases

Background  Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.
Methods  From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.
Results  All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.
Conclusions  Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

     

硬脊膜动静脉瘘的血管造影诊断与栓塞治疗

目的　探讨硬脊膜动静脉瘘的血管造影诊断与栓塞治疗价值。方法　回顾性分析 2 8例硬脊膜动静脉瘘的选择性血管造影与栓塞治疗资料 ,所有患者均行全脊髓动脉血管造影检查。结果　 2 8例硬脊膜动静脉瘘经血管造影检查均能明确诊断 ,能显示病变的范围、血供情况及其特征 ,其特点为硬脊膜动脉与脊髓表面静脉直接相通。 18例 (占64 .3 % )硬脊膜动静脉瘘位于脊柱左侧 ,10例 (占 3 5 .7% )位于右侧 ;2 3例瘘口 (占 82 .1% )位于胸 3与腰 2椎体平面之间。经超选择插管后 17例患者接受了栓塞治疗 ,其中 12例行栓塞后手术切除。随访观察见患者临床症状改善者 11例(占 64 .7% ) ,病情稳定者 4例 (占 2 3 .5 % ) ,病情加重者 2例 (占 11.8% )。所有栓塞病例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硬脊膜动静脉瘘安全而较为有效的治疗手段。