Willis覆膜支架治疗颈内动脉海绵段假性动脉瘤与瘘

目的 探讨使用Willis覆膜支架治疗颈内动脉海绵窦段假性动脉瘤与瘘的可行性、有效性。方法 回顾性分析2013年1月到2017年12月收治的15例颈内动脉海绵窦段假性动脉瘤和1例颈内动脉海绵窦瘘的临床资料,均采用Willis覆膜支架置入术治疗。结果 术后即刻血管造影显示病变完全消失,载瘤动脉通畅。术后死亡2例;其余14例术后随访6~24个月,均恢复正常工作,DSA或CTA随访未见复发,但1例放疗病人出现颈内动脉海绵窦段慢性闭塞。结论 Willis覆膜支架治疗颈内动脉海绵窦段假性动脉瘤与瘘成功率高,操作简单。     

覆膜支架在颈内动脉海绵窦段病变治疗中的应用

目的 评价应用覆膜支架治疗颈内动脉海绵窦段病变的价值.方法 采用覆膜支架治疗11例颈内动脉海绵窦段病变,其中颈内动脉海绵窦瘘5例,颈内动脉海绵窦段动脉瘤6例,术后1年行全脑血管造影随访和临床随访.结果 11例患者中,成功应用覆膜支架治疗9例,成功置入覆膜支架的9例患者,术后即刻血管造影显示病变完全消失,临床症状逐渐好转,无手术相关并发症,术后1年行全脑血管造影复查8例,结果显示病变消失,责任动脉均保持通畅.结论 覆膜支架在处理颈内动脉海绵窦段动脉瘤或颈内动脉海绵窦瘘方面,有治疗成功率高,疗效好,并发症少,复发率低等特点,值得推广.     

动脉瘤性颈内动脉海绵窦瘘的血管内治疗

目的总结应用血管内技术治疗颈内动脉海绵窦段动脉瘤破裂导致颈内动脉海绵窦瘘(CCF)的经验体会。方法回顾性分析8例颈内动脉海绵窦段动脉瘤破裂致CCF患者的临床资料以及应用的血管内技术,其中单纯应用可脱球囊治疗1例,弹簧圈结合可脱球囊进行治疗2例,球囊辅助弹簧圈栓塞治疗2例,覆膜支架治疗1例。结果8例患者中6例治疗成功,无技术相关性并发症;1例治疗前突然死亡;1例放弃治疗。结论血管内技术是治疗颈内动脉海绵窦段动脉瘤破裂致CCF的安全、有效方法。     

海绵窦造影在颈动脉-海绵窦瘘及其并发症中的诊断和治疗意义

目的 了解颈动脉一海绵窦瘘(carotid-cavernous fistula,CCF)的血流动力学变化和颈内动脉海绵窦段及其周围静脉窦和静脉的病理改变,为制定更为合理的治疗方案提供依据。方法 1990年4月～1999年4月共收治CCF患者124例,28例施行眼上静脉(superior ophthalmic vein,SOV)海绵窦造影,其中A型17例,B型1例,D型10例。结果 海绵窦造影显示,海绵窦接近正常者12例(42.86％),其中海绵窦狭窄3例,网状海绵窦9例。海绵窦扩大者16例(57.14％),包括局限性扩张呈静脉湖状14例,其中海绵窦囊性占位者5例,即囊中囊表现,提示存在外伤性动脉瘤;海绵窦分隔2例。辅助动脉造影检查发现,CCF合并同侧颈动脉闭塞者2例,颈动脉狭窄3例,合并外伤性动脉瘤5例,其中2例发生严重鼻出血。28例均经眼上静脉入路或眼上静脉+动脉入路闭塞CCF及假性动脉瘤,治疗效果良好。结论 眼上静脉-海绵窦造影与颈动脉造影结合,于动脉外闭塞CCF瘘口或闭塞海绵窦瘘,可提高CCF治疗的成功率并保持载瘘动脉的通畅率,有助于CCF合并颈内动脉海绵窦段损伤及外伤性动脉瘤的诊断与治疗。     

覆膜支架治疗完全盗血型颈动脉海绵窦瘘

目的探讨覆膜支架用于血管内治疗完全盗血型颈动脉海绵窦瘘(CCF)的效果。方法自2008年7月至2009年5月,应用覆膜支架对6例完全盗血型CCF进行血管内治疗。结果5例患者覆膜支架均成功释放于瘘口处,瘘口消除并保持颈内动脉通畅,1例因颈内动脉海绵窦段过度迂曲无法到达理想位置。全组无手术相关并发症发生。术后3个月时,4例患者获脑血管造影随访,显示颈内动脉通畅,但1例患者颈外动脉海绵窦瘘较术后即刻更加明显。结论对于完全盗血型CCF,覆膜支架血管内治疗是其可供选择的有效治疗方法之一。     

覆膜支架血管内治疗颅内动脉瘤:附九例报告

目的探讨覆膜支架治疗颅内动脉瘤的适应证和临床疗效。方法经脑血管造影检查明确诊断的9例颅内动脉瘤患者(4例颈内动脉海绵窦段宽颈动脉瘤未破裂、5例椎动脉颅内段梭形或夹层动脉瘤破裂致蛛网膜下隙出血),动脉瘤直径4～16mm,均接受Jostent覆膜支架治疗。结果共计植入9枚Jostent覆膜支架,均获技术成功,支架顺利到达病变部位且释放后动脉瘤颈即刻覆盖完全,动脉瘤不显影,载瘤动脉血流通畅,达到即刻影像学满意效果。随访9～24个月,5例患者(2例颈内动脉、3例椎动脉)脑血管造影检查颈内动脉支架段血流通畅、无狭窄(2例),椎动脉支架段血管呈无症状性闭塞(2例)或支架内轻度狭窄(1例),动脉瘤均未显影;其余4例未行脑血管造影患者门诊随访。9例患者手术后均恢复正常生活与工作,无一例死亡或永久性病残。结论覆膜支架治疗颈内动脉海绵窦段宽颈大动脉瘤、椎动脉颅内段梭形或夹层动脉瘤疗效较好,值得在有手术适应证的患者中推荐使用。     

海绵窦造影的颈动脉－海绵窦瘘及其并发症中的诊断和治疗意义

目的：了解颈动脉-海绵窦瘘（carotid-cavernous fistula，CCF）的血流动力学变化和颈内动脉海绵窦段及其周围静脉窦和静脉的病理改变，为制定更为合理的治疗方案提供依据。方法：1990年4月-1999年4月共收治CCF患124例，28例施行眼上静脉（superior ophthalmic vein，SOV）海绵窦造影，其中A型17例，B型1例，D型10例。结果：海绵窦造影显示，海绵窦接近正常12例（42.86%），其中海绵窦3例，网状海绵窦9例。海绵窦扩大16例（57.14%），包括局限性扩张呈静脉湖状14例，其中海绵窦囊性占位5例，即囊中囊表现，提示存在外伤性动脉瘤；海绵窦分隔2例。辅助动脉造影检查发现，CCF合并同侧颈动脉闭塞2例，颈动脉例，合并外伤性动脉瘤5例，其中2例发生严重鼻出血。28例均经眼上静脉入路或眼上静脉 动脉入路闭塞CCF及假性动脉瘤，治疗效果良好。结论：眼上静脉-海绵窦造影与颈动脉造影结合，于动脉外闭塞CCF瘘口或闭塞海绵窦瘘，可提高CCF治疗的成功率并保持载瘘动脉的通畅率，有助于CCF合并颈内动脉海绵窦段损伤及外伤性动脉瘤的诊断与治疗。     

经鼻蝶入路垂体腺瘤切除术并发颈内动脉损伤的诊断与治疗

目的 探讨经鼻蝶入路垂体腺瘤切除术中和术后并发颈内动脉损伤的预防、诊断及治疗原则.方法 4例施行经鼻蝶入路垂体腺瘤切除术的患者均并发颈内动脉损伤,其中颈内动脉破裂出血2例,颈内动脉假性动脉瘤1例,颈内动脉海绵窦瘘1例.结果 2例颈内动脉破裂出血患者,分别经颈内动脉球囊栓塞术和颈内动脉腔内覆膜支架植入术完全闭塞破裂口,手术后均未再出现新的神经功能障碍.其余2例患者也分别经颈内动脉腔内覆膜支架植入术和海绵窦瘘球囊栓塞术治愈.结论 经鼻蝶入路垂体腺瘤切除术中并发的颈内动脉损伤是一严重的手术并发症,可通过手术前影像学检查、手术中准确定位加以预防;脑血管造影检查可及时显示颈内动脉损伤的类型和部位,并通过颈内动脉球囊栓塞术和腔内覆膜支架植入术进行治疗.     

覆膜支架血管内治疗颅内动脉瘤：附九例报告

目的探讨覆膜支架治疗颅内动脉瘤的适应证和临床疗效。方法经脑血管造影检查明确诊断的9例颅内动脉瘤患者（4例颈内动脉海绵窦段宽颈动脉瘤未破裂、5例椎动脉颅内段梭形或夹层动脉瘤破裂致蛛网膜下隙出血）,动脉瘤直径4～16mm,均接受Jostent覆膜支架治疗。结果共计植入9枚Jostent覆膜支架,均获技术成功,支架顺利到达病变部位且释放后动脉瘤颈即刻覆盖完全,动脉瘤不思影,载瘤动脉血流通畅,达到即刻影像学满意效果。随访9～24个月,5例患者（2例颈内动脉、3例椎动脉）脑血管造影检查颈内动脉支架段血流通畅、无狭窄（2例）,椎动脉支架段血管呈无症状性闭塞（2例）或支架内轻度狭窄（1例）,动脉瘤均未显影;其余4例未行脑血管造影患者门诊随访。9例患者手术后均恢复正常生活与工作,无一例死亡或永久性病残。结论覆膜支架治疗颈内动脉海绵窦段宽颈大动脉瘤、椎动脉颅内段梭形或夹层动脉瘤疗效较好,值得在有手术适应证韵患者中推荐使用。     

颅底骨折并发颈内动脉假性动脉瘤的介入治疗

目的 探讨对颅底骨折引起颈内动脉假性动脉瘤的治疗方法及其疗效。方法 2007年1月至2014月11月收治颅底骨折并发假性动脉瘤5例,2例为海绵窦段假性动脉瘤合并颈内动脉海绵窦漏,3例为单纯颈内动脉假性动脉瘤,均采用介入治疗。结果 5例均治愈,未发生死亡及脑梗死。结论 颅底骨折时应注意有无脑血管并发症的存在,尤其是假性动脉瘤,介入治疗是其理想治疗方法。     

False aneurysm of cavernous carotid artery and carotid cavernous fistula: complications following transsphenoidal surgery

We present two cases of carotid injury during transsphenoidal surgery for pituitary adenoma. While in one of the cases it resulted in the formation of a false aneurysm of cavernous carotid artery, in the other patient, a carotid cavernous fistula (CCF) formed. The false aneurysm was managed by surgical trapping and the patient had an uneventful recovery. The CCF was initially managed with balloon embolization. The balloon got deflated and resulted in a false aneurysm with persistent CCF. This was occluded with Guglielmi Detachable Coils (GDC). The management options are discussed and relevant literature is reviewed. We emphasize the importance of an early cerebral angiography to know the status of the injured carotid artery and formation of false aneurysm / fistula.     

联合自膨胀颅内支架和生物活性弹簧圈栓塞1例海绵窦宽颈动脉瘤

目的报道采用自膨胀专用颅内支架Neuroform和生物活性弹簧圈Matrix栓塞1例宽颈海绵窦动脉瘤的经验.方法对一女性48岁多发性脑动脉瘤病人,在栓塞其破裂的前交通动脉瘤后5个月,采用国际上第1个专用颅内支架Neuroform和第1种具有生物活性的弹簧圈Matrix栓塞另一伴发的宽颈海绵窦动脉瘤.结果支架成功置入载瘤动脉的瘤颈处,并经插入支架网眼内的微导管在动脉瘤内填入3个Matrix电解脱弹簧圈,动脉瘤闭塞95%以上,载瘤动脉通畅.病人无神经功能症状,弥散加权MR未见脑缺血灶,MRA和TCD未见脑血管痉挛,术后5 d出院.结论Neuroform颅内支架使用方便、安全,适用于颅内宽颈动脉瘤的支架辅助弹簧圈栓塞,特别适用于迂曲的脑血管.     

A novel technique for identifying the fistulous point in a direct carotid-cavernous fistula

The fistulous point in a direct carotid-cavernous fistula (CCF) can often be difficult to identify because of high-flow shunting. A novel technique that is useful for identifying the fistulous point is reported. A 71-year-old woman underwent endovascular therapy for a left direct CCF that presented with sudden diplopia and tinnitus. To identify the fistulous point, vertebral angiography with manual compression of the left carotid artery was attempted, as was slow injection of a contrast agent from a balloon guiding catheter, closing off the left internal carotid artery; however, the shunt flow was very rapid, and identification was not possible. Therefore, three-dimensional digital subtraction angiography of the vertebral artery was performed while also performing manual aspiration from the balloon guiding catheter, closing off the left internal carotid artery. This reduced early visualization of the cavernous sinus and enabled an aneurysm in the cavernous sinus to be clearly visualized. Embolization was performed transarterially and transvenously, and the shunt flow disappeared completely. Vertebral angiography combined with manual aspiration from a balloon guiding catheter closing off the internal carotid artery is useful for identifying the fistulous point in a direct CCF.     

Giant aneurysm treated by bilateral cervical carotid artery to proximal middle cerebral artery bypass and balloon embolisation: a case report

The authors describe a case of a 59 year-old Chinese lady with a history of spontaneous left caroticocavernous fistula in 1988 treated by left internal carotid artery clipping and muscle embolisation. She subsequently presented with a subarachnoid haemorrhage in November 1997 secondary to rupture of an unclippable giant right internal carotid artery aneurysm. This was treated satisfactorily with bilateral cervical carotid artery to proximal middle cerebral artery bypass followed by balloon occlusion. Postoperatively, the patient has no neurological deficit and CT angiogram shows good patency of both grafts 6 months after surgery.     

Usefulness of ultrasonography in a case of spontaneous carotid-cavernous fistula: a case report]

Since spontaneous carotid-cavernous fistula (CCF) is a dural arterio-venous fistula at the cavernous sinus, which is different from traumatic CCF and CCF associated with a ruptured aneurysm at the cavernous internal carotid artery, cerebral angiography is required in order to differentiate these condition. We here report a case of spontaneous CCF, in which a result of ultrasonographic evaluation of cervical arteries well corresponded with that of cerebral angiography. Ultrasonography showed increased blood flow and decreased pulsatility index in the ipsilateral external carotid artery, contralateral internal and external arteries, and these values in all arteries resolved within normal range after the interventional embolization. Ultrasonography is less invasive examination and can be easily performed even in outpatients for observation of spontaneous CCF.     

Glue Embolization of Ruptured Anterior Thalamoperforating Artery Aneurysm in Patient with Both Internal Carotid Arteries Occlusion

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.