颈静脉球瘤术前血管内治疗的应用价值

目的 评价颈静脉球瘤术前造影及栓塞的应用价值.方法 14例颈静脉球瘤经CT和MRI及五官科详细检查评价,所有患者于术前行双侧颈动脉及患侧椎动脉造影,栓塞供血动脉及瘤巢,7例患者行患侧颈内动脉球囊阻断试验以了解Willis环功能,栓塞后48 h手术切除颈静脉球瘤.结果 14例颈静脉球瘤术前造影和供血动脉及瘤巢栓塞均获成功,肿瘤切除术中出血明显减少,7例颈动脉球囊阻断试验均获成功,3例术中施行颈内动脉结扎术,术后及随访期未出现新的神经系统症状或体征.结论 颈静脉球瘤术前行供血动脉和瘤巢栓塞及颈内动脉球囊阻断试验安全可靠,可作为常规的术前准备.     

神经介入治疗在颈静脉球瘤术前栓塞中的应用价值

目的探讨神经介入治疗在颈静脉球瘤术前造影和栓塞的应用价值。方法收集19例颈静脉球瘤患者均经手术病理证实,所有患者于术前行双侧颈内、外动脉和椎动脉造影检查,随即行供血动脉栓塞,于栓塞术后72h内行手术切除。结果 19例颈静脉球瘤患者均成功行脑血管造影,造影显示由颈外动脉供血。所有患者均栓塞成功,17例完全栓塞,2例大部分栓塞。外科手术中显示16例肿瘤切除时出血明显减少;3例出血较多。结论术前栓塞颈静脉球瘤对于减少术中出血,提供清晰手术视野,减少对毗邻重要神经和血管的损伤有重要作用。术前栓塞是安全可靠的,可作为术前常规应用。     

颈静脉球瘤的栓塞治疗

目的:评价介入栓塞治疗对颈静脉球瘤的作用.方法:3 例颈静脉球瘤患者,采用Seldinger技术行超选择性插管造影明确病变部位及其供血动脉,然后灌注聚乙烯醇颗粒(PVA颗粒)适量.结果:3例患者肿瘤供血动脉均被栓塞,肿瘤染色消失;2例栓塞后1周行手术切除,均完全切除且出血量少.栓塞后随访观察,患者的临床症状均减轻或消失.结论:颈静脉球瘤的栓塞治疗对于减少术中出血和抑制肿瘤生长有积极的作用,术前栓塞加外科手术切除是治疗颈静脉球瘤的一种安全有效的方法.     

介入放射学在颈部副神经节瘤的临床评价

目的评价介入放射学在颈部副神经节瘤的术前应用。方法分析13例颈部副神经节瘤病例,对6例副神经节瘤行术前栓塞,对9例行球囊阻断试验,了解Willis环功能。结果6例颈部副神经节瘤术前造影及部分供血动脉栓塞均获成功,术中出血明显减少,9例颈动脉阻断(测定Willis环功能)试验全部成功,在术中施行颈动脉结扎术,术中及术后随访未出现新的神经系统症状或体征。结论颈部的副神经节瘤术前栓塞及术前球囊阻断试验安全、可靠,可作为常规术前准备。     

鼻咽血管纤维瘤术前双重介入栓塞的临床价值

目的探讨双重介入栓塞对治疗鼻咽血管纤维瘤的临床价值。方法7例鼻咽血管纤维瘤患者,术前均行DSA造影检查,其中6例病灶主要由上颌动脉及颈内动脉分支供血,均行双重介入栓塞治疗即局部穿刺瘤体内直接栓塞 供瘤动脉栓塞;另1例仅上颌动脉供血,故仅行供瘤动脉栓塞。结果所有病灶在栓塞后造影检查中均明显缩小。结论双重介入栓塞治疗可作为鼻咽血管纤维瘤术前必备的辅助治疗措施。     

头颈部副神经节瘤的术前栓塞治疗

目的：分析头颈部副神经节瘤的ＤＳＡ表现及评价术前栓塞的作用。材料与方法，８例患者均行双侧颈总动脉及椎动脉ＤＳＡ检查，而后行患侧超选择性插管，以明胶海绵颗粒或真丝段作为栓塞材料。结果：５例颈静脉球瘤，２例颈动脉体瘤及１例迷走神经体瘤的动脉期均显示主要由颈外动脉的分支供血，如咽升动脉，耳后动脉，枕动脉等，颈静球瘤如侵犯后颅凹，颈内动脉或椎动脉的分支也可参与供血，实质期，肿瘤呈分叶状，不均匀染色，静脉期     

颈静脉球瘤的DSA表现及术前栓塞治疗

目的：分析颈静脉球瘤的ＤＳＡ表现，评价栓塞治疗的作用。材料和方法：患者５例（男性３例，女性２例）。采用Ｓｅｌｄｉｎｇｅｒ技术，行超选择性动脉插管并造影；栓塞剂采用明胶海绵颗粒和／或真丝线段，分次缓慢注入栓塞材料，栓塞过程中监测肿瘤血管及供血动脉闭塞情况。结果：５例颈静脉球瘤。ＤＳＡ动脉期表现为颈静脉孔、乳突区或后颅凹大片血管团块影，其间血管婉蜒迂曲，颈外动脉之咽升动脉、耳后动脉、枕动脉为主要供血动脉，颈内动脉脑膜垂体干、椎动脉之脑膜支、小脑后、前动脉可参与供血。实质期肿瘤呈湖状、巢状染色。静脉期２例肿瘤较大者见粗大的引流静脉丛向下引流至颈内静脉。栓塞后肿瘤的供血动脉大多被栓塞，肿瘤染色明显减少或消失。栓塞术后７天内行手术，肿瘤完全或大部分切除。结论：ＤＳＡ是显示颈静脉球瘤供血动脉的最佳方法，根据ＤＳＡ表现，可以准确确定肿瘤的位置和侵犯范围。术前栓塞为手术切除提供了良好条件。     

颈动脉体瘤的术前造影和栓塞

目的了解颈动脉体瘤的血供情况及术前栓塞对术中出血、手术全切率和术后疗效的影响.材料与方法18例颈动脉体瘤患者行数字减影血管造影,并经5F造影导管用直径2501000μmIvalon对肿瘤供血动脉进行栓塞处理.结果颈动脉体瘤主要由同侧的颈外动脉分支供血,同侧颈内动脉参与供血的占1/18,椎动脉参与供血的占2/18.供血动脉栓塞后肿瘤染色大部分消失,术中出血明显减少.结论颈动脉体瘤的术前栓塞有助于减少术中出血,增加手术安全性,提高手术全切率和术后疗效.     

脑膜瘤的DSA及术前栓塞治疗

目的探讨脑膜瘤血管造影表现及手术前栓塞治疗的应用。方法36例经病理确诊的脑膜瘤,术前全部行全脑血管DSA造影,将其中主要由颈外动脉供血的22例患者用PVA栓塞,栓塞治疗后3～10d行手术切除。结果36例患者中,单纯由颈外动脉供血的9例,颈外动脉和颈内动脉供血的25例,颈内动脉供血2例。22例行肿瘤供血动脉栓塞的患者中,栓塞后肿瘤血管染色完全消失16例,染色明显减轻6例。栓塞后行手术切除的22例脑膜瘤患者,病灶被全部切除,术中平均出血150～500ml。结论脑膜瘤可由颈内、颈外动脉单独或混合供血,脑膜瘤的术前颈外动脉栓塞有利于减少术中出血及肿瘤的完整切除。     

鼻咽血管纤维瘤术前供血动脉栓塞的临床应用

目的探讨鼻咽血管纤维瘤术前供血动脉栓塞的临床应用价值。方法7例患者,确诊为鼻咽血管纤维瘤。为控制术中出血,采用Seldinger技术,行供血动脉造影及栓塞治疗。栓塞剂为明胶海绵、PVA颗粒。另选7例为术前未行供血动脉栓塞直接手术切除的鼻咽血管纤维瘤患者作为对照组,对术中出血、输血量作比较。结果7例行供血动脉栓塞患者术中出血量及输血量明显减少,两者比较差异有显著性;手术见瘤周水肿明显,易于剥离。结论鼻咽血管纤维瘤术前供血动脉栓塞术对于减少术中出血具有明显疗效。     

头颈部副神经节瘤影像学诊断

目的:探讨头颈部副神经节瘤的影像学特征。方法:回顾性分析19例头颈部副神经节瘤的CT、MRI和DSA表现,其中颈静脉球瘤3例,鼓室球瘤2例,颈动脉体瘤12例,迷走体瘤2例。结果:颈静脉球瘤的CT特征为颈静脉孔扩大和虫蚀骨质破坏,1例双侧因肿瘤为1cm首次平扫漏诊;鼓室球瘤均较小,发生于鼓岬区,临床特征为搏动性耳鸣和鼓膜充血;颈动脉体瘤位于颈总动脉分叉处,特征为颈内、外动脉分离和动脉镶嵌于肿瘤边缘或肿瘤内;迷走体瘤与颈动脉体瘤的区别在于颈内、外动脉受压后均向前移位。增强后肿瘤均见明显强化,MRA图像有助于确认肿瘤内的滋养血管,术前栓塞是治疗的有效方法,能减少约50%~70%肿瘤供血。结论:头颈部副神经节瘤具有特定的解剖学位置和影像学表现,对临床诊断和治疗有重要价值。     

富血供巨大脑膜瘤术前栓塞的临床应用

目的评价经动脉栓塞术（TAE）对巨大富血供脑膜瘤术前栓塞的临床意义。方法 32例巨大富血供脑膜瘤患者（男性18例,女性14例,年龄38～65岁,平均56.5岁）为确认肿瘤供血动脉,先经选择性血管造影（DSA）,随后又经术前TAE。全部TAE操作是采用Seldinger技术将150～300μm的聚乙烯醇（PVA）微粒或海藻酸钠（KMG）微球超选择地注入病灶血管床及供血动脉完成。对全部患者获自DSA与TAE的资料进行了回顾性分析。结果 DSA证实,在32例脑膜瘤患者的肿瘤供血动脉中,主要为颈外动脉分支供血者见于22例,颈内、外动脉供血各占50%者6例,颈内动脉供血者占90%以上者4例;脑膜瘤供血动脉大部分栓塞者15例,部分栓塞10例,未栓塞7例。在肿瘤大部分栓塞患者的切除术中,出血量明显减少,手术时间显著缩短,肿瘤易被彻底切除。未发生与栓塞操作有关的严重并发症。结论脑膜瘤术前介入栓塞能减少术中出血,降低手术难度,可作为富血供脑膜瘤切除术前的一项重要的、常规性辅助措施。     

颈动脉损伤的血管内介入治疗

目的 评价采用介入技术经血管内治疗颈动脉损伤的安全性和疗效.方法 对111例经数字减影血管造影(DSA)确诊的颈动脉损伤患者进行血管内治疗.本组颅外段颈内动脉(ICA)损伤1例,采用覆膜支架封闭颈动脉破裂口),颅内段颈内动脉损伤110例,采用球囊栓塞73例,弹簧圈栓塞12例,注射α-氰基丙烯酸正丁酯(NBCA)栓塞6例,覆膜支架封闭破裂口11例,应用多种材料联合栓塞8例.结果 血管造影显示颅外段颈内动脉动静脉瘘(AVF)1例,创伤性颈动脉海绵窦瘘(TCCF)83例,创伤性颅内段颈内动脉假性动脉瘤14例,TCCF合并假性动脉瘤13例.治疗均获成功,颈动脉保留通畅62例,临床症状消失110例,好转1例.并发症2例,无死亡患者.术后跟踪随访1～14个月,其中16例经DSA复查,临床症状复发3例,其中2例经补充栓塞治愈,1例继续临床观察.结论 应用介人技术包括经导管超选择性栓塞术和覆膜支架置人术治疗颈动脉损伤是损伤小、安全且有效的方法.     

Transarterial balloon-assisted n-butyl-2-cyanoacrylate embolization of direct carotid cavernous fistulas

BACKGROUND AND PURPOSE: Transarterial detachable balloon embolization of direct carotid cavernous fistulas (DCCFs) has become an optimal treatment. In a few cases, the parent artery has to be sacrificed to achieve morphologic cure. We present our experience with transarterial balloon-assisted n-butyl-2-cyanoacrylate (n-BCA) embolization of DCCFs in which there was failure to achieve angiographic cure and preservation of parent arteries. METHODS: Of 141 patients with traumatic DCCFs who had been treated by transarterial embolization with occlusion of the fistula and parent artery preservation, 18 received transarterial balloon-assisted n-BCA embolization-6 for residual fistula after the balloons detached, 7 for recurrent fistula because of premature balloon deflation or migration, and 5 for repeated puncture of the detachable balloon by the bony fragment at the cavernous sinus. A total of 27 procedures were performed with an average 1.5 attempts per patient, and the volume of the n-BCA mixture varied from 0.5 to 2.3 mL with a mean of 0.83 mL. RESULTS: All DCCFs were successfully occluded by the n-BCA mixture with preservation of parent arteries. One patient with a giant cavernous sinus varix had a fatal subarachnoid hemorrhage. One had a recurrence and was treated by internal carotid artery (ICA) occlusion. Five had asymptomatic pseudoaneurysms at the parent artery. There was no adhesion of the n-BCA mixture to the protective balloon or the microcatheter or n-BCA reflux into the parent arteries. CONCLUSION: Transarterial balloon-assisted n-BCA embolization is a feasible, efficient, and safe treatment for DCCFs when angiographic cure and ICA preservation are not achieved by transarterial detachable balloon embolization.     

Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization

Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32–82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.     

Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions

Preoperative embolization was performed in 39 patients with 44 paragangliomas of the head and neck. Because of their complex vascular supply and their relation to vital structures such as the internal carotid artery and the lower cranial nerves, paragangliomas of the temporal bone represent challenging lesions to both the neuroradiologist and the otoneurosurgeon. Detailed classification by high-resolution CT and recognition of the multi- or monocompartmental vascular composition and of dangerous situations by selective angiography are essential prerequisites for safe and effective devascularization of paragangliomas of the temporal bone. Major complications that may occur if embolic material reaches intraaxial vessels through anastomoses between external carotid artery branches and the internal carotid and/or the vertebral artery can be avoided with the use of specific precautionary techniques. Palsies of the facial and lower cranial nerves can also be avoided if reabsorbable material is used for embolization of vessels supplying cranial nerves in asymptomatic patients. In selected cases with significant supply from the internal carotid artery, special interventional techniques, including embolization of the pericarotid tumor portion through the caroticotympanic artery and pre- or peroperative balloon occlusion of the petrous internal carotid artery, allow radical removal of extensive paragangliomas of the temporal bone. Techniques and selection of materials for embolization of carotid body, vagal body, and other paragangliomas of the head and neck mainly depend on the vascular composition of the tumor and on the specific vascular territory in which the tumor is located. In this series, preoperative embolization significantly improved surgical conditions of paragangliomas of any location in the head and neck and proved to represent an essential prerequisite for successful surgery of extensive paragangliomas of the temporal bone.