Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients

Twenty-eight symptomatic dural fistulas involving the transverse and sigmoid sinuses were treated between 1978 and 1986 with a variety of treatment modalities. Occipital artery compression therapy resulted in a complete cure in two of nine patients (22%) and improvement in three of nine (33%). There were no complications from this treatment. Patients who were excluded or in whom compression therapy failed were treated with embolization alone or in conjunction with surgery. Of the 17 patients who underwent embolization alone, ten were cured and six were improved. Six patients had a combination of embolization and surgery; four patients were cured and two improved. There were three complications in this series, one related to surgery and two related to embolization.     

Transvenous embolization of direct carotid cavernous fistulas

Of 165 cases of direct carotid cavernous fistula, 14 (8.5%) were treated from a transvenous approach. Twelve of these were treated through the inferior petrosal sinus and one through the superior ophthalmic vein. In one patient, both approaches were used. The embolic agents were as follows: five patients had balloons only, four patients had minicoils alone, three patients had coils and liquid adhesives, one had balloons and coils, and one had balloons and liquid adhesives. Among the patients who were treated from a transvenous approach, three had an occluded carotid artery caused by trauma, nine failed transarterial balloon attempts, and one had a prior trapping procedure. In the remaining patient, who had Ehlers-Danlos syndrome, a transarterial approach was judged to be too dangerous. This patient suffered a fatal pontine hemorrhage after subtotal transvenous occlusion of the carotid cavernous fistula with diversion of flow into cortical veins. Another complication occurred when the inferior petrosal sinus was perforated during catheterization, causing a small subarachnoid hemorrhage. The tear was immediately closed with minicoils, and surgical exposure and embolization resulted in complete cure. Of the remaining 12 patients treated, 11 were completely cured and one showed angiographic and clinical improvement. Transarterial balloon embolization remains the procedure of choice in the treatment of symptomatic carotid cavernous fistulas; however, transvenous embolization is an alternative when the arterial route fails.     

Direct puncture of the proximally occluded internal carotid artery for treatment of carotid cavernous fistulas

Three patients with symptomatic carotid cavernous fistulas (CCFs) characterized by complete occlusion of the proximal internal carotid artery were treated by percutaneous puncture and embolization. Two patients had CCFs associated with traumatic dissections of the internal carotid artery and were treated initially with trapping procedures. Both patients had persistent symptoms related to the CCF and underwent additional surgical procedures (ophthalmic artery ligation and intraoperative embolization) without improvement. The third patient had traumatic occlusion of the internal carotid artery. After direct percutaneous puncture of the carotid artery above the occlusion, a catheter was advanced into the petrous internal carotid artery. Balloons (one case) or coil emboli (two cases) were placed into the cavernous sinus to produce CCF closure. There were no complications from this procedure. Direct puncture of the carotid artery is an alternative treatment for patients lacking safe access for CCF embolization.     

Long-term clinical outcome of spontaneous carotid cavernous sinus fistulae supplied by dural branches of the internal carotid artery

We report the long-term clinical outcome of spontaneous carotid cavernous sinus fistulae (CCF) originally supplied by branches arising from the internal carotid artery (Barrow's type B), or type-D lesion that became type B after particulate embolization. A total of 55 patients was included in this study. Their angiography revealed that cortical drainage was absent, and that the arteries supplying the fistulae originated in the dural branches of the internal carotid artery. Thirty-two patients had type-D lesions, which became type-B lesions after obliteration of the external carotid supply by endovascular treatment. The other 23 patients had type-B lesions documented by angiography, and had no embolization. The follow-up period ranged from 8 to 144.5 months. Clinical cure was achieved in 39 patients (70.9%), improvement in eight patients (14.5%), the lesion remained stable in four patients (7.3%), and was aggravated in four patients (7.3%). The number of drainage veins is the only radiographic factor that could predict the outcome. Those patients with single draining veins had a better chance of complete remission. The outcome between the group with original type D lesions after embolization and the group with original type B revealed no statistically significant difference. The time-course to complete cure was significantly shorter in the group with embolization of the external carotid supply. In the four patients whose symptoms were aggravated, embolization was performed, and the result was excellent. The clinical outcome of type-B CCF, or type D converted to type B, is good. Previous external carotid artery embolization can significantly shorten the time to complete cure. Aggressive treatment should be reserved for those who have aggravated symptoms.     

小脑后下动脉瘤血管内栓塞治疗的初步临床研究

目的 探讨小脑后下动脉(PICA)瘤栓塞治疗的方法及效果.方法 回顾性分析21例PICA瘤经血管内栓塞治疗的临床资料,根据DSA资料估计动脉瘤的解削分段.采取单纯弹簧圈栓塞8例、单纯液体胶栓塞5例、弹簧圈联合液体胶栓塞2例、支架辅助弹簧圈栓塞2例、球囊辅助弹簧圈PICA闭塞4例,用格拉斯哥预后(GOS)评分评估疗效.结果 单纯弹簧圈致密栓塞5例,90%以上栓塞2例,85%栓寒1例;单纯液体胶栓塞的5例及弹簧圈联合液体胶栓塞的2例均达到致密栓塞;支架辅助弹簧圈栓塞的2例90%以上栓塞;球囊辅助弹簧圈完全闭塞载瘤动脉3例,90%以上栓塞1例.术后脑干穿支动脉闭塞导致死亡1例,术后1周新发神经功能障碍1例,其余未见再出血及小脑损害症状.术后随访6～60个月,平均(22±8)个月.COS评分Ⅰ级1例,Ⅱ级1例,Ⅲ级2例,Ⅳ级5例,Ⅴ级12例.结论 根据PICA瘤的解剖分段选择不同的栓塞方法,可取得良好的治疗效果.     

Internal carotid aneurysms presenting with mass effect symptoms of cranial nerve dysfunction: efficacy and imitations of endosaccular embolization with GDC

OBJECTIVE: The authors report a retrospective analysis of their experience in the endosaccular embolization of internal carotid aneurysms which caused mass effect symptoms of cranial nerves (CN) and review the efficacy and limitations of this technique. METHODS: Between April 1997 and August 2002, 12 internal carotid aneurysms that caused mass effect symptoms of CN were treated by endosaccular GDC embolization with parent artery preservation. The locations were the cavernous internal carotid artery (CV) in six patients, carotid-ophthalmic artery (CO) in two patients, and posterior communicating artery (PCo) in four patients. The angiographical size of the aneurysms ranged from 6 to 20 mm, with a mean of 13.3 mm. Duration of symptoms ranged from 0.5 to 120 months, with a mean of 13.7 months. All aneurysms were treated by endosaccular guglielmi detachable coil (GDC) embolization with preservation of the internal carotid artery. RESULTS: Five patients (42%) had complete resolution of symptoms, four (33%) had significant improvement of symptoms, and three (25%) were unchanged. Immediate posttreatment angiographic studies revealed neck remnant (NR) in nine patients and dome filling (DF) in three patients. In one patient (case 10), the resolved symptoms became worse 29 months later. Follow-up angiograms were obtained in 10 patients, and recanalization was observed in four of them (40%). Transient thrombotic complication occurred in only one patient. The group with resolution or improvement of symptoms demonstrated a shorter duration of symptoms before GDC treatment (< or = 12 months). CONCLUSION: Even subtotal endosaccular embolization of aneurysms may reduce mass effect symptoms of cranial nerves. However, careful follow-up is needed because subtotal occlusion carries a future risk of growth.     

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。     

Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization: initial success and rate of permanent cure

BACKGROUND AND PURPOSE: Endovascular treatment with cyanoacrylate embolization is an option when complete obliteration of the nidus of an intracranial arteriovenous malformation (AVM) is the goal. Our purpose was to evaluate the rates of initial success and permanent cure of such treatment in a Chinese population. METHODS: Twenty-seven consecutive patients with an intracranial AVM underwent endovascular embolization with cyanoacrylate between June 1995 and May 1997. Twenty-six patients had cerebral AVMs and one had a cerebellar AVM. Curative embolization was attempted in 10 patients in whom 1) the nidus was not larger than 3 cm, 2) the number of feeders did not exceed three, and 3) the nidus was accessible with the tip of the catheter. We used a flow-directed microcatheter and a 20-25% mixture of cyanoacrylate in contrast medium. Long-term outcomes were observed angiographically and clinically. RESULTS: Complete embolization was achieved in six patients. No procedure-related complications occurred during attempted curative embolization. Follow-up angiography performed at 17-32 months showed complete obliteration of the AVM nidus in the six patients after initial embolization. These patients remained asymptomatic 5-7 years after treatment. The rate of permanent cure of the initially complete embolization was 100% (six of six). The success rate of endovascular cure for patients treated with curative intent was 60% (six of 10). The overall cure rate was 22% (six of 27). CONCLUSION: The overall initial cure rate of intracranial AVM with cyanoacrylate embolization was 22%. Initial angiographic evidence of complete embolization indicated permanent cure in these patients.     

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.     

Transvenous embolization of dural fistulas involving the cavernous sinus

Because of the risks associated with arterial embolization of cavernous dural fistulas, we have sought an alternative method to promote fistula closure. Thirteen patients underwent transvenous embolization as a treatment for symptomatic cavernous dural fistulas. All procedures were performed from a femoral vein access through the inferior petrosal sinus or basilar plexus. In five patients the inferior petrosal sinus was not angiographically demonstrable; however, embolization was still possible through this route in two patients. The embolic agents used were detachable balloons in one patient, coils alone in five, coils and liquid adhesives in four, coils plus silk sutures in one, silk sutures alone in one, and liquid adhesives alone in one. Nine patients had follow-up angiograms, which showed complete obliteration of the fistulas and complete resolution of related symptoms. One patient had complete resolution of clinical symptoms but refused follow-up angiography. Another patient had 50% decrease in fistula flow on the follow-up angiogram and improvement in clinical symptoms. Two patients had complete fistula obliteration after embolization and progressive improvement in symptoms but follow-up angiograms had not been obtained. Follow-ups ranged from 1 to 97 months (mean, 15 months). Two complications were related to this treatment. An embolic stroke followed transient placement of a balloon in the internal carotid in one patient, and a second patient developed transient visual loss when the venous outflow pathways were occluded before fistula closure. The fistula was immediately closed with complete recovery of vision. With recent advances in microcatheter and embolic agent technology, transvenous closure of cavernous dural fistulas is now possible.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cavernous sinus dural fistulae treated by transvenous approach through the facial vein: report of seven cases and review of the literature

BACKGROUND AND PURPOSE: Dural Carotid Cavernous Fistulas (CCFs) can be treated by transarterial and/or transvenous endovascular techniques. The venous route usually goes through the internal jugular vein (IJV) and the inferior petrosal sinus (IPS) up to the pathologic shunts of the cavernous sinus. In case a thrombosed IPS, catheterization through the obstructed sinus is not always possible and a puncture of the superior ophthalmic vein (SOV) can be performed often after a surgical approach. We report our results in the endovascular transvenous treatment of dural CCFs through the facial vein (retrograde catheterization of the IJV, facial vein, angular vein, SOV, and cavernous sinus). METHODS: A retrospective study of seven patients with a dural CCF treated with transvenous embolization via the facial vein was performed. In five patients, the IPS was thrombosed. In one patient, the IPS was patent, but there was not communication between the cavernous sinus compartment in which the CCF shunts were located and the IPS itself. In the only patient with the CCF draining through permeable IPS, the transvenous route through the IPS permitted the occlusion of the posterior CCF shunts and a second session was performed through the facial vein in order to occlude the shunts of the anterior compartment of the cavernous sinus. The other six patients underwent one embolization session only. RESULTS: In all seven cases, it was possible to navigate through the tortuous junction of the angular vein and the SOV. In one patient with a thrombosed SOV, the venous procedure was interrupted because the catheterization through the occluded SOV failed. In the other six patients, after transvenous catheterization of the cavernous sinus via the facial vein, placement of coils resulted in complete occlusion of the dural CCF with clinical cure in four patients and improvement in two. CONCLUSION: In the endovascular treatment of the dural CCFs, the transfemoral approach via the facial vein provides a valuable alternative to other transvenous routes. Catheterization of the cavernous sinus via the facial vein is usually successful. Although this technique requires caution, it allows a safe and effective treatment of these lesions.     

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.     

Peripheral arteriovenous malformations with a dominant outflow vein: results of ethanol embolization.

OBJECTIVE: To assess retrospectively the treatment results of ethanol embolization of peripheral arteriovenous malformations (AVMs) with a dominant outflow vein (DOV). MATERIALS AND METHODS: Nineteen patients who had peripheral AVMs with a DOV were enrolled in this study (mean age, 29.7 years; range, 15-42 years). Fifty-one ethanol embolizations (mean, 2.7; range, 1-8) were performed by direct puncture (n = 29), the transarterial approach (n = 13), the transvenous approach (n = 5), or a combination of methods (n = 4) under general anesthesia. Coil and/or core-removed guide wire embolization of the DOV or another flow occlusion technique (i.e., use of an external pneumatic pressure cuff) to achieve vascular stasis were required in all patients during ethanol embolization. Clinical follow-up (mean, 22.2 months; range, 1-53 months) was performed for all patients, and imaging follow-up (mean, 22.1 months; range, 2-53 months) from the last treatment session was performed for 14 patients. The therapeutic outcome (cure, improvement, no change, or aggravation) was assessed according to the clinical response and the degree of devascularization at angiography. RESULTS: Ethanol embolization was considered as an effective procedure in all patients. Thirteen (68%) of 19 patients were cured and six displayed improvement. Three of six patients with improvement needed further treatment sessions for residual AVMs. Four patients (21%) experienced a total of eight complications. Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor. CONCLUSION: Peripheral AVMs with a DOV can be effectively treated with a high cure rate by the use of ethanol embolization alone or in conjunction with the use of coil and/or core-removed guide wire embolization.     

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。     

Iatrogenic Life-Threatening Pseudoaneurysms of Extracranial Internal Carotid Artery After Fine-Needle Aspiration of Cervical Lymph Nodes: Report of Two Cases in Children

Two children younger than 10 sought care for large, tense pulsatile swelling in the neck after fine-needle aspiration of cervical lymph nodes that resulted in severe respiratory distress. Computed tomographic angiography confirmed the presence of large pseudoaneurysms that caused a mass effect, leading to compression of surrounding vessels and airway. Pseudoaneurysms were successfully treated by coil embolization in one patient and surgical ligation of the internal carotid artery in the other.     

创伤性颈内动脉假性动脉瘤的血管内治疗

目的 探讨载瘤动脉闭塞、弹簧圈栓塞以及支架技术治疗颅内创伤性颈内动脉假性动脉瘤(pseudoaneurysm,PSA)的适应证及其疗效.方法 本组6例患者,3例海绵窦段PSA合并颈内动脉海绵窦痿(carotid-cavernous fistula,CCF),2例单纯颈内动脉PSA,1例CCF球囊栓塞后复查显示PSA.球囊闭塞CCF及创伤性颈内动脉PSA 1例,弹簧圈栓塞3例,颈内动脉球囊闭塞2例.根据6例患者的临床表现、影像学资料、治疗方法选择、临床疗效、随访资料以及文献,分析三种治疗方式的适应证.结果 本组患者无手术相关并发症发生,无脑缺血并发症.术后无鼻出血发生,3例眼球突出回复,1例随访半年视力改善,3例颅内杂音消失,3例瞳孔缩小,复查数字减影血管造影(DSA)未见PSA复发.结论 血管内治疗是治疗颈内动脉PSA的首选,合并CCF时可行球囊闭塞或载瘤动脉闭塞.对单纯窄颈者予以弹簧圈栓塞,对宽颈的采用支架技术结合弹簧圈栓塞,而位于颈内动脉岩段可选择带膜支架.

Abstract：

Objective To investigate the indication and result of parental artery occlusion, embolization with coils, stents in treatment of the traumatic carotid artery pseudoaneurysm. Methods There were six patients with traumatic carotid artery pseudoaneurysm including three patients of cavernous pseudoaneurysm combined with carotid-cavernous fistula (CCF), two with simple traumatic carotid artery pseudoaneurysm and one with traumatic carotid artery pseudoaneurysm that was found after CCF embolization with detachable balloon. The treatment included balloon occlusion for CCF and traumatic carotid pseudoaneurysm in one patient, coil embolization in three and intenal carotid artery balloon occlusion in two. The Clinical manifestations, imaging data, choice of treatment, clinical efficacy, follow-up data and literatures were analyzed to discuss the indications for three treatments. Results There was no cerebral ischemia or surgically-related complication. No epistaxis occurred. The eyeball protrusion restoration was found in three patients and intracranial bruit vanishing in three. Vision was improved one patient after half a year follow-up. The pupils shrank in three patients during follow - up. Digital subtraction angiography (DSA) showed no recurrence of pseudoaneurysm. Conclusions Endovascular treatment is the preferred choice of treatment for traumatic carotid artery pseudoaneurysm. The occlusion or parent artery balloon occlusion can be used when the pseudoaneurysm is combined with CCF. Coil embolization can be used for shoes with narrow neck, stent technology combined with coil embolization for those with wide neck and the covered stent for the rock section of the internal carotid artery.     

Postcatheterization radial arteriovenous fistula: balloon-assisted direct percutaneous embolization with N-butyl cyanoacrylate and 50 % glucose solution in two sessions

We report an iatrogenic radial arteriovenous fistula (AVF) in a 74-year-old woman presenting with right radial bruit and pain 8 months after sheath removal for cardiac catheterization. She refused surgical ligation and underwent balloon-assisted direct percutaneous embolization of the draining vein with N-butyl cyanoacrylate (NBCA). Another draining vein that developed immediately after the procedure was conservatively treated with 1 month of continuous band compression. However, its diameter gradually increased and, as the patient desired complete remission, an additional procedure was conducted 2 months after initial treatment. A second balloon-assisted direct percutaneous embolization was performed using a 50 % glucose solution, which resulted in complete resolution. Although surgical repair is considered to be the standard treatment, in patients where surgery is not indicated, endovascular intervention—although complicated—may be an alternative treatment modality.     

Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

INTRODUCTION: We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. METHODS: Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. RESULTS: Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a "magic wand" appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n = 2), transvenous embolization (TVE; n = 2), and TAE/TVE (n = 1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. CONCLUSION: The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction.     

创伤性颈动脉假性动脉瘤病因及诊治探讨

目的对创伤性颈动脉假性动脉瘤病因及血管内栓塞治疗进行探讨。方法对26例患者行数字减影血管造影术(DSA)检查明确诊断，同时行血管内栓塞治疗。5例采用微弹簧圈栓塞，19例采用可脱性球囊行假性动脉瘤开口处颈动脉闭塞，2例采用10％α-氰基丙烯酸正丁酯(NBCA)脑膜中动脉供支栓塞。结果20例栓塞后鼻腔出血停止，其中1例视力下降栓塞后1周视力好转。3例头痛3周后消失。3例颈部包块杂音消失、质软、无搏动。1例死亡。随访6-12个月无一例再次出血，颈部包块消失。结论血管内栓塞是治疗创伤性颈动脉假性动脉瘤有效的方法。     

Comparative study of covered stent with coil embolization in the treatment of cranial internal carotid artery aneurysm: a nonrandomized prospective trial

To evaluate whether Willis covered stent implantation yielded angiographic and clinical results were better than those with coil embolization. Eighty-nine patients with cranial internal carotid artery (CICA) aneurysms were treated nonrandomly with covered stents (n = 43, group A) or coil embolization (n = 46, group B). Data on the technical success, procedure time, initial and final angiographic results, and final clinical outcomes were collected and analyzed at >6 months post-procedure. Covered stent placement and coil embolization were successful in all patients, except for one patient in group A. The initial angiographic results showed complete occlusion in 34 group-A patients (80.9%; 95% CI: 69%, 93%) and 24 group-B patients (52.2%; 95% CI: 37%, 67%) (P = 0.004). The final angiographic results indicated complete occlusion in 39 group A patients (39/41, 95.1%; 95% CI: 88%, 102%) and 22 group B patients (48.9%; 95% CI: 34%, 64%) (P < 0.001). The average procedure time was shorter in group A than that in group B (P < 0.001). CICA aneurysm treatment with covered stents yielded better intermediate-term angiographic outcome than those with the recommended approach of coil embolization. (ClinicalTrials.gov number, NCT01029938)