静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘

目的总结经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘的手术经验。方法回顾性分析15例海绵窦区硬脑膜动静脉瘘的临床资料,均采用Onyx或联合可脱性弹簧圈填塞病变侧海绵窦,同时闭塞瘘口。经股静脉-岩下窦入路11例,经股静脉-面静脉-眼上静脉入路4例。结果治疗后即刻造影显示海绵窦和瘘口完全闭塞14例,残留少量眼上静脉引流1例(术后6个月复查造影显示残留瘘口消失)。术后眼部症状加重1例,经对症治疗术后6d症状逐渐改善;展神经麻痹1例,自行恢复。随访3～28个月,未见复发病例。结论 Onyx经静脉入路栓塞海绵窦区硬脑膜动静脉瘘是安全有效的。     

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。     

经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘(附8例报告)

目的探讨经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘的方法及效果。方法 8例海绵窦区硬脑膜动静脉瘘患者,分别经股静脉-岩下窦、股静脉-面静脉-眼上静脉、直接开放眼上静脉入路到达病变侧海绵窦,用GDC可控微弹簧圈和ONXY胶等多种栓塞材料填塞海绵窦,同时闭塞瘘口。结果 7例治疗后即刻造影显示海绵窦和瘘口完全闭塞,临床症状消失。1例虽将海绵窦闭塞,但仍残留翼丛引流,临床症状明显缓解,术后行压颈治疗后症状消失。栓塞术后最常见并发症为头痛伴呕吐及外展神经麻痹,1周后缓解。5例患者术后随访3～26个月症状未见复发,其中4例均于术后3月复查DSA未见异常,1例残留瘘口的患者术后6月行脑血管造影复查,显示残留瘘口消失。结论经静脉入路栓塞是治疗海绵窦区硬脑膜动静脉瘘安全、有效的方法。     

经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘

目的 探讨经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘的效果、面临的问题及相应的处理。方法 经股静脉-岩下窦入路和经股静脉-面静脉-眼上静脉入路到达病变侧海绵窦，用GDC、EDC、游离弹簧圈和丝线等多种栓塞材料填塞海绵窦，同时闭塞瘘口。结果 应用两种静脉入路对13例病人的17侧海绵窦进行了栓塞治疗。10例治疗后即刻造影显示海绵窦和瘘口完全闭塞。3例虽将海绵窦闭塞，但仍残留岩下窦的引流(1例)和翼丛引流(2例)。栓塞术后最常见症状为头痛伴呕吐。1例伴有动眼神经麻痹的病例在栓塞治疗后其它眼部症状消失，但动眼神经功能仍未恢复。随访3个月到26个月未见复发。3例残留瘘口的病例均于术后3个月行脑血管造影复查：2例残留瘘口消失，1例仍有翼丛引流。其他病例未行脑血管造影复查。结论 经静脉途径栓塞治疗是海绵窦区硬脑膜动静脉瘘的有效方法，应作为首选治疗方法。     

血管内治疗海绵窦区硬脑膜动静脉瘘的疗效分析

目的探讨海绵窦区硬脑膜动静脉瘘（CS-DAVF）的血管内栓塞治疗的技巧及疗效。方法采用血管内栓塞治疗经DSA确诊的CS-DAVF患者34例,其中17例经动脉入路,15例静脉入路,2例经动、静脉联合入路;采用Onyx栓塞17例,弹簧圈栓塞6例,Onyx联合弹簧圈栓塞7例,1例采用Gluebran栓塞。结果 17例经动脉入路栓塞患者中,Class分级1级栓塞10例,2级栓塞6例,3级栓塞1例;15例经静脉脉入路栓塞患者中,1级栓塞10例,2级栓塞2例,3例栓塞失败;2例经动静脉联合入路栓塞患者中,1级栓塞1例,2级栓塞1例。31例成功栓塞的患者术后2例出现动眼神经麻痹,2例Onyx误栓同侧大脑中动脉。18例经DSA随访3~36个月,14例1级栓塞的患者未见复发;4例2级栓塞者2例瘘口完全闭塞,2例仍见瘘口。结论血管内栓塞是治疗CS-DAVF首选方法,依据供血动脉、瘘口特点及引流静脉选择不同途径进行个体化治疗,可以取得满意疗效。     

经静脉入路栓塞治疗横窦-乙状窦区的硬脑膜动静脉瘘

目的评价经静脉入路栓塞治疗横窦-乙状窦区硬脑膜动静脉瘘(DAVF)的安全性和有效性。方法经静脉入路到达患侧的横窦-乙状窦,用微弹簧圈填塞病变静脉窦,同时闭塞瘘口。结果经静脉入路治疗横窦-乙状窦区DAVF共16例。病变累及横窦-乙状窦交界处者11例、横窦者3例、乙状窦者2例。根据Cognard分类,IIa型3例,IIb型1例,IIa b型12例。单纯应用静脉入路7例,经静脉入路前先采用经动脉途径栓塞者8例,经静脉入路栓塞治疗后再经动脉途径栓塞者1例。瘘口完全闭塞13例,瘘口残留3例,但瘘口流量已减少95%以上。15例(94%)在栓塞治疗后临床症状消失,1例栓塞后出现颅内出血死亡,未见其他并发症。随访4～23个月,临床症状无复发。11例行造影复查:3例残留瘘口者2例消失,1例曾行3次造影复查瘘无明显变化,由于无临床症状,未再行栓塞治疗;另外8例造影复查未见复发。结论对于适当选择的横窦-乙状窦区DAVF病例,经静脉入路闭塞病变静脉窦是一种安全有效的治疗方法。     

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.     

静脉入路Onyx胶联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘

目的探讨Onyx胶联合弹簧圈经静脉途径栓塞治疗海绵窦区硬脑膜动静脉瘘（CDAVF）的可行性及效果。方法经全脑血管造影确诊CDAVF20例,均经静脉途径用Onyx胶联合弹簧圈栓塞治疗。结果本组20例均治愈,栓塞后1例出现外展神经麻痹,经对症处理后痊愈。随防3个月～1年,20例患者均无复发。结论应用Onyx胶联合弹簧圈经静脉入路栓塞治疗CDAVF是一种安全、有效的方法。     

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.     

经岩下窦入路Onyx联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘

目的探讨经岩下窦入路Onyx联合可脱性弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘的安全性和有效性。方法回顾性分析2010年7月~2013年6月经岩下窦入路Onyx结合弹簧圈栓塞治疗的18例海绵窦区硬脑膜动静脉瘘患者的临床资料,评价疗效及手术并发症。结果栓塞后即刻血管造影显示瘘口完全闭塞15例,次全闭塞3例。4例术中出现心动过缓,3例术后出现眶部疼痛。随访3~12个月,所有患者术前症状消失,无复发。结论经岩下窦入路Onyx联合弹簧圈栓塞海绵窦区硬脑膜动静脉瘘疗效确切,安全可靠。     

Direct transcranial coil and Onyx embolization of a dural arteriovenous fistula: Technical note and brief literature review

Intracranial high-grade dural arteriovenous fistulas (DAVFs) have higher bleeding rates compared to other intracranial vascular malformations. Endovascular treatment is usually recommended for high-grade lesions, aiming at a complete fistula obliteration. However, some patients have vascular abnormalities that limit endovascular access to the precise location of the shunt. Alternative techniques may be considered in this scenario. A middle-aged man presented with intracranial hypertension secondary to a high-grade DAVF. Because of vascular abnormalities precluding transvenous access to the intracranial venous circulation, the patient required treatment by a direct transcranial coil and Onyx embolization of the shunt. Direct transcranial cannulation of a dural sinus is an alternative and effective route for transvenous embolization of DAVFs, especially if abnormal venous anatomy precluding venous access to the required cranial venous system is identified.     

经动脉途径应用Onyx胶栓塞治疗硬脑膜动静脉瘘(附16例报告)

目的探讨经动脉途径应用Onyx胶栓塞治疗颅内硬脑膜动静脉瘘(DAVF)的可行性及疗效。方法回顾性分析2007年3月至2010年10月收治的16例DAVF患者的临床资料及随访结果。经动脉途径采用Onyx胶栓塞治疗15例,动静脉联合途径1例。结果 16例患者共栓塞17次,栓塞结束即时解剖治愈14例(87.5%),另2例栓塞不全者术后辅以手术治疗。栓塞后出现动眼神经麻痹3例,面部感觉麻木3例,随访1月后症状消失;口咽部疼痛2例,应用糖皮质激素治疗后症状消失。本组无死亡病例。10例患者术后2～24个月复查DSA,1例DAVF复发,9例完全闭塞;6例门诊随访2～24个月均未见复发。结论经动脉途径应用Onyx胶栓塞治疗颅内DAVF是可行、有效的方法,效果良好。     

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。     

MRI and SPECT studies of dural arteriovenous fistulas presenting as pure progressive dementia with leukoencephalopathy: a cause of treatable dementia

We report two patients with dural arteriovenous fistulas (DAVFs) who presented with pure progressive dementia. Both patients showed only slowly progressive dementia, without headache, papilledema and other neurologic signs associated with diffuse white matter changes in MRI. MR cerebral angiography showed sigmoid sinus DAVFs that were mainly supplied by the occipital artery, together with retrograde filling of the superior sagittal and straight sinus and dilated cortical veins. SPECT studies showed extensive blood flow reduction in the occipital and parieto-occipital areas and right temporal lobe in one patient. Selective embolization for treatment of the DAVF improved cognitive function associated with the abnormal white matter MRI signal. MRI and SPECT showed that severity of dementia correlated with diffuse white matter changes and regional cerebral blood flow. Our cases suggest that gradually impaired cerebral circulation due to venous hypertensive encephalopathy could be involved in slowly progressive dementia with leukoencephalopathy resulting from a DAVF. DAVFs may be particularly important for differential diagnosis in elderly patients with pure progressive dementia. Thus, early diagnosis of DAVFs and treatment by endovascular surgery is important as treatable or reversible dementia.     

A dural arteriovenous fistula in cavernous sinus developed from viral meningitis

Although hormonal influences, inflammation, trauma, sinus thrombosis, venous hypertension, and congenital origin have been proposed as sources of dural arteriovenous fistulas (DAVFs) in cavernous and sigmoid sinuses, the etiology of these lesions remains controversial. We present a case with a cavernous sinus DAVF developed from viral meningitis which has not been previously described. A 24-year-old male was admitted to our institute because of periorbital pain, decreased vision, pulsatile tinnitus, chemosis, and exophthalmos on the right side after he had suffered viral meningitis four months before. Cerebral angiography demonstrated a cavernous sinus DAVF, which was successfully obliterated with several platinum coils using a transvenous approach. The viral meningitis most likely caused the inflammation, that may be responsible for the occurrence of the cavernous sinus DAVF. Prompt treatment for inflammation may help to prevent the development of DAVFs.     

Dural arteriovenous fistula at the foramen magnum presenting with subarachnoid hemorrhage: case reports and literature review

Background and purpose: Spinal dural arteriovenous fistulas (DAVFs) may arise at any level from the foramen magnum to the sacrum. Only a few case series of DAVFs at the foramen magnum have been reported, especially with patients presenting with subarachnoid hemorrhage (SAH). We performed a retrospective study of four such cases and summarize experiences in the diagnosis and surgical treatment of a DAVF at the foramen magnum. Methods: Four male patients, aged from 35 to 51 years, were admitted with severe headache. The cranial computerized tomography scans of all four patients showed SAH, with hemorrhage in the fourth ventricle with or without hemorrhage in the occipital horns of the lateral ventricles. Pre‐operative digital subtraction cerebral angiography showed a DAVF at the foramen magnum draining to medullary veins and/or the straight sinus and the confluence of sinuses. Two DAVFs were fed by the vertebral artery, whilst the others were fed by dural branches of the occipital artery and/or the ascending pharyngeal artery. Results: Three patients underwent direct microsurgical electrocoagulation and disconnection of the arteriovenous shunt via an enlargement of the foramen magnum and a hemilaminectomy at C1 by the far lateral suboccipital approach. Post‐operative angiography confirmed complete obliteration of the fistula. Conclusions: Cerebral digital subtraction angiography is an effective and accurate method for examination of a DAVF at the foramen magnum. It can be treated effectively and with minimal surgical trauma by microsurgical electrocoagulation and disconnection of the shunt.     

硬脑膜动静脉瘘侵袭性表现的危险因素分析

目的目前除了合并皮层静脉引流被认为是硬脑膜动静脉瘘(DAVF)的侵袭性表现的高危因素之外,尚无其他危险因素被大家所公认。本研究的目的在于通过单因素和多因素分析,阐明DAVF侵袭性表现的危险因素。方法回顾分析2007年1月至2012年12月第二军医大学长海医院临床神经医学中心收治的190例DAVF患者。其中侵袭性表现112例,非侵袭性表现78例。收集临床和影像学资料,提取人口学特征、临床表现类型、血管构筑学特征等参数,对比不同表现DAVF在上述参数上的差异,并进行Logistic回归分析。结果 Logistic回归分析发现侵袭性表现发病的独立危险因素为瘘口部位位于大静脉窦区(P0.001),引流方式为Borden II型(P0.001)和III型(P=0.002)。结论瘘口位于大静脉窦区,引流方式为Borden II型和III型是DAVF发生侵袭性表现的独立危险因素。