血管内栓塞治疗颈内动脉海绵窦瘘

目的　探讨颈内动脉海绵窦瘘 (CCF)血管内栓塞治疗的效果。方法　 5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　 5例中 ,1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 2次试放球囊入海绵窦均破裂失败 ,其中 1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 ,但患者治疗术后 1周临床症状和体征消失。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。     

可脱球囊栓塞术在海绵窦瘘治疗中的应用 (附 2 7例报告 )

目的　研究微导管可脱球囊技术治疗海绵窦瘘的临床意义。方法 :2 6例外伤性颈内动脉海绵窦瘘 (TCCF)患者和 1例大脑前动脉 (A1段 )动脉瘤破裂合并海绵窦瘘患者采用微导管可脱球囊技术进行栓塞治疗 ,以经颅多普勒 (TCD)进行复查 ,所有患者均随访 6月以上。结果 :2 2例CCF患者均成功栓塞瘘口并保持颈内动脉通畅 ,其中 2 0例为一次栓塞成功 ,2例因球囊过早泄漏而行 2次栓塞治疗。对 1例A1段动脉瘤破裂合并海绵窦瘘患者成功施行了双球囊动脉瘤颈孤立术。 4例行颈内动脉闭塞术。本组病例未发生严重并发症。结论 :微导管可脱球囊技术是对海绵窦瘘的一种微创、安全、有效的治疗方法。     

双导管球囊技术治疗高流量颈动脉海绵窦瘘

目的探讨双球囊导管技术治疗高流量颈动脉海绵窦瘘(CCF)的可行性及疗效。方法随机选择1枚可脱性球囊无法闭塞的CCF患者3例,双侧股动脉置管,送2枚球囊进入瘘口,调整位置,充盈2枚球囊,使瘘口完全闭塞后再解脱球囊,观察栓塞效果和颈内动脉通畅情况,评价该技术的可行性。结果3例患者均1次性完全闭塞瘘口,颈内动脉皆通畅,操作过程简单易行,未增加介入治疗的危险性。结论双导管球囊技术能在保证颈内动脉通畅的前提下简单有效地治疗1枚球囊无法闭塞的CCF。     

双球囊技术在外伤性颈动脉海绵窦瘘治疗中应用探讨

【摘要】 目的 总结双球囊技术（不可解脱球囊辅助可解脱球囊）在外伤性颈动脉海绵窦瘘（CCF）治疗中的应用经验,分析其适用范围及技术要点。 方法 回顾性分析采用双球囊技术行介入治疗的18例Barrow A型外伤性CCF患者。治疗过程中先在瘘口远心端放置不可解脱球囊,然后放置可解脱球囊靠近瘘口区域,适当充盈不可解脱球囊辅助可解脱球囊进入瘘口,并继续缓慢充盈不可解脱球囊挤压可解脱球囊通过瘘口进入海绵窦内,最后充盈可解脱球囊闭塞瘘口。 结果 18例患者栓塞术后造影证实瘘口均完全闭塞获成,颈内动脉通畅。术后患者颅内杂音即刻消失,球结膜充血、水肿或突眼等症状逐步消除,无颅内缺血、出血等严重并发症。随访12～48个月,1例出现复发,仍予以双球囊技术治愈,随访18个月无复发。 结论 双球囊技术治疗Barrow A型外伤性CCF患者安全有效,具有创新性、可靠、费用低的特点。     

颈动脉海绵窦瘘的血管内栓塞治疗

目的　探讨不同的栓塞材料在颈动脉海绵窦瘘 (CCF)的血管内栓塞治疗中的应用。方法　回顾分析了 2 3例CCF血管内栓塞治疗病例。其中 2 2例外伤性CCF ,19例使用了可脱性球囊 ,3例使用了金属微弹簧圈作栓塞材料 ;1例自发性CCF ,使用了NB CA胶作栓塞剂。结果　可脱性球囊栓塞 19例 ,均获得临床治愈 ,其中 12例保持了患侧颈内动脉的通畅 ,获得解剖治愈 ;金属微弹簧圈栓塞 3例 ,2例成功 ,1例因弹簧圈异位栓塞于右大脑中动脉的分支 ,导致病人失语和半身不遂 ,1例自发性CCF ,经患侧脑膜副动脉注射NBCA胶 ,部分NBCA进入海绵窦内 ,病人获得临床治愈。结论　CCF首选血管内栓塞治疗 ,而可脱性球囊是一种理想的栓塞材料。由于金属微弹簧圈可控性差 ,不够安全 ,不应再被作为经颈内动脉途径的栓塞材料。     

颈内动脉海绵窦瘘血管内栓塞治疗的临床价值

目的　探讨颈内动脉海绵窦瘘的血管内栓塞治疗。方法　对 18例外伤性颈内动脉海绵窦瘘患者 ,全部经皮股动脉穿刺行全脑DSA检查确诊 ,用可脱球囊进行栓塞治疗。结果　 18例患者全部栓塞成功 ,其中 15例同时保持颈内动脉通畅 ,1例CCF瘘口较大 ,2例球囊进入瘘口困难 ,改行闭塞瘘口的同时栓塞同侧颈内动脉。术后除 1例患者眼睛失明未恢复外 ,其余病例临床症状及体征完全消失。结论　血管内栓塞技术是目前治疗CCF的最好方法 ,具有损伤小 ,安全性高 ,疗效可靠等特点     

外伤性颈内动脉海绵窦瘘的诊断及血管内栓塞治疗

目的探讨外伤性颈动脉海绵窦瘘(TCCF)的诊断方法和血管内球囊及可脱式弹簧圈(GDC)栓塞治疗的效果。方法回顾性研究48例患者共49个瘘口进行51次栓塞治疗,其中49次应用可脱式球囊进行栓塞,2次应用GDC进行栓塞。结果49个瘘口中31个闭塞瘘口同时颈内动脉保持通畅,2例患者2周后复发,应用球囊再次栓塞。18个闭塞患侧颈内动脉,1例患者出现暂时性肢体偏瘫。2例GDC栓塞闭塞瘘口并保持颈内动脉通畅。患者临床症状基本全部消失,部分术前视力下降者恢复不良。结论物理诊断和DSA脑血管造影对TCCF诊断最有意义。可脱式球囊栓塞是治疗TCCF的良好方式,辅助GDC栓塞总体上可以达到更好的结果。     

可脱性球囊栓塞治疗外伤性颈动脉海绵窦瘘(附5例报告及文献复习)

目的：探讨不同类型的颈内动脉一海绵窦瘘（ＣＣＦ）血管造影特点，可脱性球囊栓塞治疗方法。方法：５例均为男性，都有外伤史及眼部症状和体征。全脑ＤＳＡ见海绵窦提前显影及粗大的眼静脉引流，采用ＭａｇｉｃＢＤ微导管进行栓塞。结果：一次栓塞成功并保存颈内动脉通畅３例，另２例为瘘口太小或有碎骨片致栓塞瘘口失败，改用球囊栓塞颈内动脉获得满意疗效，随访２月～２ａ均未见复发。结论：对ＣＣＦ用可脱性球囊直接栓塞瘘口或由于瘘口太大、太小或有碎骨片采用栓塞颈内动脉均能达到治疗目的     

经面静脉-眼上静脉入路治疗颈动脉海绵窦瘘

目的　评价经面静脉 眼上静脉入路治疗颈动脉海绵窦瘘 (CCF)的有效性。方法 :经股静脉 面静脉 眼上静脉入路到达患侧海绵窦 ,用GDC或EDC ,游离弹簧圈 ,真丝线段等多种栓塞材料填塞海绵窦 ,同时闭塞瘘口。面静脉插管困难者 ,在下颌角附近切开皮肤显露面静脉 ,直视下穿刺面静脉放置相应导管 ,再经眼上静脉到达患侧海绵窦并将其填塞。结果 :经面静脉 眼上静脉入路对 14例、16侧海绵窦进行了栓塞治疗 ,其中 5例为外伤性、直接CCF(A型 ) ,经动脉途径球囊栓塞后复发 ,或微弹簧圈栓塞未能成功 ,或经岩下窦入路未能成功 ,9例为自发性、间接CCF(D型 8例 ,C型 1例 )。 13例经股静脉 面静脉 眼上静脉途径 ,1例通过直视下面静脉穿刺。 11例栓塞治疗后即刻造影显示瘘消失 ,2例残留低流量的岩下窦引流 ,另有 1例在微导管进入面静脉后 ,面静脉痉挛闭塞 ,未能继续进行栓塞治疗 ,造影仍见瘘存在 ,但眼静脉出现明显的造影剂滞留。 1例A型CCF在球囊栓塞后出现外展神经麻痹 ,经面静脉 眼上静脉栓塞后亦无改善。因面静脉痉挛闭塞未能栓塞成功者 ,于术后即感眼部症状加重 ,但第 2天感症状缓解 ,术后第 2 1天症状明显改善 ,造影检查发现瘘口已经消失 ,术后 1个月患者眼部症状完全消失。其他病例在栓塞术后眼部症状明显改善 ,     

经动脉入路血管内治疗142例创伤性颈内动脉海绵窦瘘临床分析

目的 验证经动脉入路血管内治疗对创伤性颈内动脉海绵瘘(CCF)的治疗效果.方法 142例经全脑血管造影确诊为颈内动脉海绵窦瘘,行常规可脱球囊栓塞术,其中7例行球囊栓塞失败,改为全麻下行Jostent覆膜支架成形术.结果 135例患者局麻下成功行可脱球囊栓塞术,7例行球囊栓塞失败后于全麻下成功行Jostent覆膜支架成形...     

眼球后常见良性占位的磁共振与病理对照研究

总结球后良性肿瘤的ＭＲＩ检查，分析它们在球后的ＭＲＩ表现，并结合病理讨论ＭＲＩ表现与病理的对应关系。材料与方法：共３８例，男性２５例，女性１３例，年龄５－６３岁，平均４１．５岁。ＭＲＩ检查使用中场超导ＭＲＩ成像系统，８例做了ＭＲＩ增强检查。结果：血管瘤１５例，炎性假瘤１１例，脑膜瘤２例，泪腺混合瘤７例，神经纤维瘤３例，ＭＲＩ论断符合率为８９．５％。结论：（１）ＭＲＩ有较高的定位和定性诊断正确率；（     

Osteomyelitis: detection with US

To evaluate the role of ultrasound (US) in the detection of osteomyelitis, the authors prospectively studied 48 patients clinically suspected of having osteomyelitis. A sonographic diagnosis was made if fluid was seen directly in contact with bone, without intervening soft tissues. Twelve of the 48 patients were subsequently found to have osteomyelitis. In 10 of them, US demonstrated abnormal fluid adjacent to the bone. This fluid was thought to represent an inflammatory exudate dissecting in a subperiosteal and/or extraperiosteal location. Eight of the 48 patients had soft-tissue fluid collections. The rest of the patients either had no abnormalities or had cellulitis. The authors conclude that US can be useful in the detection of osteomyelitis.     

Cholelithiasis: evaluation with CT

Computed tomography (CT) is often the first imaging modality used in the diagnosis of patients with suspected abdominal disease. While it is known that early generation CT scanners often detect gallstones, the detection rate of newer equipment is not widely known. Abdominal CT scans of 226 patients who had undergone ultrasonographic (US) studies of the gallbladder were reviewed in a blinded study to determine the accuracy of state-of-the-art CT scanning equipment in the detection of cholelithiasis. Of 110 patients with US or surgical evidence of cholelithiasis, gallstones were demonstrated on CT images of 87 (79.1% sensitivity). Overall accuracy was 89.8%, while specificity was 100%. On CT images stones could appear densely (48.3%) or slightly (11.5%) calcified, as an area with a rim of increased density (21.8%), as an area of soft-tissue density (14.9%), or as an area of low density (3.4%). Stone size, stone density, section incrementation, and the pericholecystic anatomy affected the detection rate. Understanding the spectrum of findings and the other factors involved can optimize success of diagnosis of cholelithiasis on the basis of CT examinations.     

Impotence: evaluation with cavernosography

Many patients with organic impotence do not have abnormalities of the penile arterial system. To determine the function of the venous system in erection, cavernosography was performed in 187 impotent men during artificial induction of erection with monitoring of intracavernous pressure and inflow. To evaluate the mechanism of active erection, 69 patients also received intracavernous injections of papaverine. Venous leakage was found in 88 patients. In these patients, a higher than normal rate of flow of diluted, heparinized contrast medium was required to initiate and maintain erection. Opacification of the prostatic plexus also occurred during erection in these patients. In all patients who received papaverine, the flow rates required to initiate and maintain erection decreased. The authors conclude that cavernosography and cavernometry are essential in the work-up of impotence and that papaverine may be helpful in elucidating the active mechanism of erection.     

Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms

BACKGROUND AND PURPOSE: The GDC system is a valuable therapeutic alternative to surgical treatment of intracranial aneurysms. We present our clinical experience with the GDC technique used to treat unruptured cerebral aneurysms. METHODS: This is a retrospective review of 217 patients with 247 unruptured intracranial aneurysms who underwent embolization with GDCs between August 1991 and June 2000. One hundred sixty-seven of the 217 were female patients. Patient age ranged from 13 to 83 years. In 118 patients, the aneurysms were found when unrelated non-neurologic conditions indicated angiography, CT angiography, or MR angiography (group 1). Fifty-one patients with mass effect symptoms comprised group 2, 12 patients with aneurysms associated with arteriovenous malformations or tumors of the brain comprised group 3, 17 patients with unruptured aneurysms treated during the chronic phase of subarachnoid hemorrhage (SAH) comprised group 4, and 19 patients treated during the acute phase of SAH due to another ruptured aneurysm comprised group 5. RESULTS: Angiographic results revealed complete occlusion in 138 of 247 aneurysms (55.9%), neck remnants in 92 (37.2%), and incomplete occlusion in three (1.2%). GDC embolization was attempted unsuccessfully in 14 aneurysms (5.7%). Of the 198 patients without acute SAH (groups 1-4), 186 (93.9%) of 198 remained neurologically unchanged. Eleven of the 217 patients (5.1%) experienced neurologic deterioration caused by immediate procedural complications. One patient died (0.5%) as a result of aneurysmal rupture during embolization. For asymptomatic patients and those treated after the chronic period of SAH, the mean hospitalization stay was 2.9 days. CONCLUSION: GDC technology constitutes safe treatment for unruptured aneurysms, with successful anatomic and clinical results and low complication rates achieved.     

Renal involvement in children with lymphoma: comparison of CT with sonography

In order to determine whether real-time sonography or contrast-enhanced CT was better for detecting renal involvement by lymphoma in children, we retrospectively studied 44 patients (6 months to 19 years of age) in whom lymphoma was diagnosed at our hospital during a 5-year period. In no patient was there any clinical evidence of renal disease at the time of presentation. In 39 patients, sonographic and CT findings were similar (normal in 36 patients and showing extrinsic mass effects on the kidneys in three patients). In five patients with non-Hodgkin lymphoma whose contrast-enhanced CT scans showed low-attenuation renal nodules, renal sonography was normal in two, showed renal enlargement in two, and showed a solitary hypoechoic nodule in one patient with multiple, bilateral nodules on CT. Tissue diagnosis of the renal lesions was not obtained, but in the four patients who had follow-up CT, the renal abnormalities resolved after chemotherapy. Our findings suggest that contrast-enhanced CT is superior to sonography for detection of renal lymphoma in children.     

Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography

We assessed the diagnostic accuracy of multislice CT in detection of intracranial aneurysms in patients presenting with subarachnoid or intracranial haemorrhage. Multislice CT and multiplanar digital subtraction angiography (DSA) images were obtained in 50 consecutive patients presenting with subarachnoid (SAH) and/or intracranial haemorrhage and reviewed by three neuroradiologists for the number, size and site of any aneurysms. The CT data were assessed using multiplanar reformats (MPR), maximum-intensity projections (MIP), surface-shaded display (SSD) and volume-rendering (VRT). In conventional angiography 51 aneurysms were detected in 41 patients. CT angiography (CTA) showed up to 48 aneurysms in 39 patients, depending on the observer. The overall sensitivity of multislice CT was 83.3% for small (<4 mm), 90.6% for medium-size (5–12 mm) and 100% for large (>13 mm) aneurysms. The sensitivity of multislice CTA to medium-size and large intracranial aneurysm is within the upper part of the range reported for helical single-slice CT. However, as small aneurysms may not be found, DSA remains the standard technique for investigation of SAH.     

Ru-labeled ruthenocenoyl-glycine: comparison of clearance with hippuran

Ruthenocenoyl-glycine (ruppuran) is a metallocene analog of iodo-labeled hippuran. After injection of ¹⁰³Ru-labeled ruppuran and ruthenocenoyl-1,1-diglycine in rabbits, measurement with external detectors revealed a very rapid accumulation in the kidneys followed by rapid excretion of the ¹⁰³Ru activity. By measurement of the radioactivity concentration in plasma and urine samples collected 1–60 min after IV injection, the plasma clearance was calculated and compared with the clearance of ¹²⁵I-labeled hippuran injected simultaneously. The clearance of ruppuran and ruthenocenoyl-diglycine in rabbits was found to be somewhat higher than that of hippuran. Extrapolating to man (1.73 m³), plasma clearance with both ruthenocene derivatives was approximately 500–600 ml/min. Biochemical data as well as the nuclear properties of ⁹⁷Ru indicate the usefulness of ⁹⁷Ru-labeled ruthenocenoyl-glycine as a radiopharmaceutical for kidney function studies.