可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘

目的 探讨外伤性颈内动脉海绵窦瘘（ＴＣＣＦ）的神经血管内介入治疗技术。材料与方法 应用法国Ｂａｌｔ公司的同轴可脱性球囊技术,在数字减影（ＤＳＡ）监视下,对１２例ＴＣＣＦ患者施行可脱性球囊栓塞治疗。结果 ９例患者成功地用球囊闭塞了颈内动脉瘘口,同时也保持了颈内动脉通畅;２例由于球囊进入瘘口困难,１例ＣＣＦ瘘在,改行闭塞瘘口同时闭塞了颈内动脉,术后除１例失明未恢复外,其余病例临床症状完全消失。结论 可     

可脱性球囊栓塞治疗颈内动脉-海绵窦瘘

1997年 5月～ 1999年 5月 ,我院应用可脱性球囊栓塞治疗颈内动脉 海绵窦瘘 (ＣＣＦ) 38例 ,疗效肯定 ,现报道如下。资料与方法一、一般资料本组 38例患者中 ,男性 32例 ,女性 6例 ,年龄为 18～ 62岁。外伤性 34例 ,男性 2 9例 ,女性 5例。自发性 4例中 ,男性 3例 ,女性 1例。二、临床表现1.持续性颅内杂音 38例。 2 .眼部症状 :球睑结膜充血、水肿、溃疡 38例 ;搏动性突眼及眼球运动障碍 35例。 3.视力减退、面部麻木、头痛、鼻出血等 4例。三、治疗方法1.术前行血常规、出凝血时间、心电图检查、碘过敏试验 ;2 .全脑血管造影 ,用Ｓｅｌｄ…     

可脱性球囊栓塞治疗Barrow A型颈动脉海绵窦瘘

目的探讨可脱性球囊栓塞治疗创伤性颈动脉海绵窦瘘的疗效及应用价值。资料与方法 18例Bar-row A型创伤性颈动脉海绵窦瘘,采用可脱性球囊经股动脉途径闭塞颈内动脉破口处或破口处患侧颈内动脉主干。结果术后18例颅内血管性杂音立即消失,16例闭塞了瘘口,颈内动脉主干保持通畅;2例同时闭塞了瘘口及颈内动脉主干。随访6～12个月,无复发。结论使用可脱性球囊栓塞治疗创伤性颈动脉海绵窦瘘创伤小、恢复快、安全可行,近期疗效确切。     

可脱球囊治疗外伤性颈内动脉海绵窦瘘

目的：研究外伤性颈内动脉海绵窦瘘的栓塞治疗。材料与方法：本文对5例外伤性颈内动脉海绵窦瘘患者施行了血管内介入栓塞术。所有患者均于手术前行Matas试验。结果：4例患者经可脱球囊栓塞术治疗，颈内动脉海绵瘘消失，颈内动脉保持通畅，颈内动脉海绵窦瘘的临床综合征于治疗后消失。1例由于瘘口较大，球囊不能完整闭塞瘘口，因该患者健侧颈内动脉代偿供应患侧的能力差，故无法栓塞患侧颈内动脉，栓塞术后该患者临床症状及体征有所改善但未能完全消除。结论：栓塞治疗对于外伤性预内动脉海绵窦瘘是一种有效治疗方法。     

球囊栓塞治疗外伤性颈内动脉海绵窦瘘17例

1993年至今 ,我们采用介入球囊栓塞术 ,治疗颈内动脉 -海绵窦瘘 17例 ,效果良好。1　临床资料1 1　一般情况　 17例中 ,男 13例 ,女 4例 ;年龄 18～ 4 4岁 ,平均 35岁。左侧病变 8例 ,右侧 9例。均有明确头部外伤史。车祸 10例 ,棍棒伤 5例 ,拳击伤 1例 ,牲畜踢伤 1例。均为搏动性突眼 ,患侧视力减退 15例 ,失明 2例 ;颅内杂音 14例 ,眼球运动障碍 9例 ,耳鸣 3例。外院长期误诊 2例中 ,失明 1例。1 2　影像学检查　均行全脑血管数字减影确诊。除检查患侧颈内动脉外 ,在压迫患侧颈总动脉的同时 ,分别行对侧颈内动脉和椎动脉造影 ,目的是 :(1)…     

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。     

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     

颈内动脉海绵窦瘘的血管内栓塞治疗

目的；探讨颈内动脉海绵窦瘘血和内球囊栓塞治疗之效果。材料与方法：７例患者均行ＤＳＡ全脑血管造影明确明确瘘口部位。叙述发现瘘口应注意的造影环节。结果：７例中５例球囊栓塞成功，保留了颈内动脉的通畅。１例行患侧颈内动脉闭塞。另１例属Ｄ型，栓塞效果不满意。结论；海绵窦瘘全脑血管造影可明确瘘口部位、大小及分型。单纯性海绵窦瘘大部分为外伤性、首选的治疗方法是血管内球囊栓塞治疗。     

可脱性球囊栓塞治疗外伤性直接型颈动脉海绵窦瘘的护理体会

目的 总结可脱性球囊栓塞治疗外伤性直接型颈动脉海绵窦瘘的护理经验.方法 回顾性分析18例外伤性直接型颈动脉海绵窦瘘患者术前、术中、术后护理方法.结果 介入治疗外伤性直接型颈动脉海绵窦瘘,无一例发生与护理相关的并发症.结论 科学和规范的护理在外伤性直接型颈动脉海绵窦瘘的介入治疗中取得了良好效果,切实有效的护理措施对保证手术成功及促进患者的康复具有重要意义.     

颅内动脉瘤的可脱性球囊栓塞治疗

目的：探讨可脱性球囊在颅内动脉瘤介入治疗中的价值及缺点,并探讨不同大小动脉瘤的栓塞技巧。方法：20例动脉瘤患者中,小动脉瘤8例（12mm）,大动脉瘤7例（12－25mm）,巨大动脉瘤5例（＞25mm）。15例患者行动脉瘤腔内直接栓塞治疗,6例行载瘤动脉闭塞。结果：14个采用球囊行瘤腔内栓塞的动脉瘤中,3个月后DSA随访,10个动脉瘤被完全栓塞,4个动脉瘤部分栓塞。6例采用球囊行载瘤动脉闭塞的动脉瘤患者,3个月DSA随访皆未见动脉瘤显影。结论：颅内大动脉瘤或巨大动脉瘤的可脱性球囊瘤腔内直接栓塞治疗是一种行之有效的治疗方法,外科不能手术或行瘤腔内直接栓塞治疗难度较大的某些动脉瘤,载瘤动脉的闭塞治疗仍不失为一种有效的治疗方法。     

Use of Glubran 2 acrylic glue in interventional neuroradiology

Introduction Glubran 2 is a cyanoacrylate-based synthetic glue modified by the addition of a monomer synthesized by the manufacturer. With this material it is possible to obtain the stability of endovascular embolization that is needed to treat tumours and vascular disease. Material and methods We report our 3-year experience of the use of Glubran for treating extracerebral tumours, spinal tumours, spinal arteriovenous malformations, and brain and spine dural fistulae. Glubran 2 was diluted with Lipiodol and injected in a continuous column with the flow rate monitored by seriography. The injection was stopped when retrograde flow was displayed in the afferent vessel. Results There were no periprocedural or subsequent clinical complications and the glue resulted in successful selective permanent occlusion with intralesional penetration similar to the angiographic features of microcatheterization. Conclusions The embolization procedure was technically straightforward and relatively safe. However, Glubran 2 can be difficult to use and the procedure does carry major risks for patients. Glue injection requires in-depth study of the lesion, its circulation and the collateral circulation to avoid severe complications due to inappropriate use. This paper was awarded the Lucien Appel Prize ESNR 2003.     

The use of detachable balloons in neuroradiology

The development of the detachable balloon allows treatment of many neurological lesions, both congenital and acquired. We describe here a device that may be used easily. Complications and main indications are discussed on the basis of our experience with 114 cases.     

Transmural migration of an intracavernous carotid detachable balloon used to control surgically induced haemorrhage

We report a case in which a balloon detached in the carotid siphon for control of iatrogenic bleeding migrated to the oesophagus. We discuss the pathophysiology. Received: 22 September 1997 Accepted: 11 November 1997     

脑肿瘤介入性治疗技术的应用研究

目的：探讨脑肿瘤介入性治疗技术的可行性及临床应用价值。方法：采用动脉插管技术、注入利尿剂及阿片类药物,以降低颅内压,破坏血脑屏障,提高脑肿瘤化疗效果,对筛选后病人介入治疗后进行球囊闭塞试验,以提高外科手术切除率。结果：１４例患者,介入治疗２０次,显效：２例;有效：９例,稳定：２例;无效：１例。结论：脑肿瘤动脉途径超选择灌注给药疗效肯定,如何再提高疗效及远期效果如何。有待进一步研究。     

Standards of practice in interventional neuroradiology

The growing importance of INR has resulted in the need to define and promote professional standards of clinical practice. Several professional organizations have published guidelines recently for the neurointerventional treatment of cerebrovascular diseases, including technical and personal recommendations, but detailed definitions of technical and organizational conditions needed for the safe and effective performance of such treatments are lacking. To fill this gap ESNR, ESMINT and the UEMS Division for Neuroradiology established a working group, to develop a consensus paper on “Standards of Practice in Interventional Neuroradiology”. This document is the result of the Consensus Working Group and has following review gained approval by the Executive Boards of ESNR and ESMINT and by the members of the UEMS Division for Neuroradiology in 2017.

     

电解可脱弹簧圈栓塞颅内动脉瘤术中颅内压、脑氧和脑糖代谢的变化

目的　对比观察血管内栓塞和开颅夹闭治疗颅内动脉瘤对病人术中颅内压、脑氧和脑糖代谢的影响。方法　选择Hunt分级为Ⅰ～Ⅲ级的脑动脉瘤择期手术 4 4例 ,按治疗方法分为电解可脱弹簧圈 (GDC)栓塞 (Ⅰ组 )和开颅脑动脉瘤夹闭 (Ⅱ组 ) ,各 2 2例。分别观察麻醉后手术前 (T0 )、脑动脉瘤夹闭前 (GDC栓塞前 ,T1)和夹闭后 10min(GDC栓塞后 ,T2 )等时相脑脊液压 (CSFP)、动脉瘤跨壁压 (TMP)和脑氧、脑糖代谢等指标及术毕麻醉恢复情况。结果　Ⅰ组 :与T0 比较 ,T1和T2 的颈内静脉球部血氧饱和度 (SjvO2 )明显增加 ,脑氧摄取率 (ERO2 )减少 ,差异具有显著性 (P <0 0 5 ) ,脑动静脉血糖差 [D(a jv)BG]、乳酸浓度差 [D(a jv)BL]和血氧差 [D(a jv)O2 ]等指标无明显变化 (P >0 0 5 )。Ⅱ组 :与T0 比较 ,T1和T2 的D(a jv)BL和D(a jv)BG增加 ,D(a jv)O2 减少 ,差异具有显著性意义 (P <0 0 5 ) ,SjvO2 和ERO2 差异无显著性意义 (P >0 0 5 )。Ⅰ组 :与T0 比较 ,T1和T2 的CSFP和TMP无明显变化 (P >0 0 5 )。Ⅱ组 :与T0 比较 ,T1和T2 的CSFP降低 ,TMP增加 ,差异具有显著性 (P <0 0 5 )。与Ⅰ组比较 ,Ⅱ组T1和T2 相应时相的CSFP降低 ,TMP增加 ,差异具有显著性意义 (P <0 0 5 )。与Ⅱ组比较 ,Ⅰ组术毕自主呼吸恢复时     

Isolated oculomotor nerve palsy in interventional neuroradiology

Background

Isolated oculomotor nerve palsy (IOP) can be annoying for a patient and can also be the only clue to a potentially devastating and life-threatening disease. In order to understand its clinical spectrum and management better we analyzed the files of 13 patients seen at our institution over a 3-year period.

Methods

Thirteen consecutive patients with IOP between January 2005 and August 2008 presented to our hospital. Magnetic resonance imaging and angiography were employed as investigations tailored to the individual patient. A vascular disorder [i.e. arteriovenous fistula, aneurysm of the posterior communicating artery (Pcoma)] was found in 7 patients (63%), most commonly a dural carotid-cavernous sinus fistula (DCCF) or a Pcoma aneurysm.

Results

In 7 patients with a vascular abnormality (4 DCCFs; 3 Pcoma aneurysms), IOP was the presenting symptom. Pcoma aneurysms were coiled endovascularly and DCCFs were managed transvenously. Of the patients with more than 1 year (6 months to 2 years) of follow-up, all 7 endovascular patients recovered completely. Time to complete resolution of ONP was 6 months.

Conclusion

Patients with IOP should be investigated with noninvasive techniques (MRI and MRA). If these are negative or to clarify abnormal findings of noninvasive techniques, selective angiography is needed for diagnosis and to guide treatment.