海绵窦区硬脑膜动静脉瘘的栓塞治疗

目的：探讨海绵窦区硬脑膜动静脉瘘的病因及诊治方法。方法：21例均采用超选择插管栓塞，其中4例同时静脉入路微弹簧圈海绵窦内栓塞。结果：17例瘘口完全消失；4例栓塞后瘘口有残留，结合颈动脉压迫法治疗后2例瘘口消失。结论：血管内栓塞治疗海绵窦区硬脑膜动脉瘘是目前行之有效的方法。     

静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘临床分析

目的综合性的比较静脉入路联合液体胶和弹簧圈介入栓塞海绵窦区硬脑膜动静脉瘘[1](CSDAVF)与可脱弹簧圈栓塞治疗CSDAVF的优缺点,确定治疗该病的最佳方案。方法回顾性的分析我院随访的20例2007～2011年期间进行静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘的患者,其中经静脉入路联合液体胶和弹簧圈介入栓塞海绵窦区治疗CSDAVF者13例,设为A组;经可脱弹簧圈栓寒治疗CSDAVF者7例设为B组。将两组的治疗结果进行比较分析。结果 A组治愈13例,治疗费用(10.5±3.4)万元,B组治愈5例,2例好转治疗费用(17.1±3.8)万元。结论静脉入路联合液体胶和弹簧圈介入栓塞海绵窦区硬脑膜动静脉瘘为理想的治疗方法。     

海绵窦区硬脑膜动静脉瘘的诊断及治疗

海绵窦区硬脑膜动静脉瘘的诊断及治疗段传志李铁林刘连红徐如祥作者单位：５１０２８２广州，第一军医大学珠江医院神经外科海绵窦区硬脑膜动静脉瘘（ＤｕｒａｌａｒｔｅｒｉｏｖｅｎｏｕｓｆｉｓｔｕｌａｓＤＡＶＦｓ）是海绵窦及其附近硬脑膜动静脉间的异常交通，又称海...     

多静脉途径介入栓塞海绵窦区硬脑膜动静脉瘘

目的探讨多静脉途径介入栓塞海绵窦区硬脑膜动静脉瘘的方法、策略和疗效。方法27例海绵窦区硬脑膜动静脉瘘患者,分别经岩下窦、面静脉和眼上静脉等静脉途径介入栓塞治疗。结果23例临床治愈,4例症状明显缓解。术后即刻造影提示22例瘘口完全消失,5例虽将海绵窦致密填塞,但其中2例仍有少量翼丛引流,1例通过海绵间窦向对侧引流,2例存在少量岩上窦后引流,压颈1个月后消失。栓塞术后并发症主要表现为头痛和呕吐,3例出现轻度复视,后自行恢复;无1例出现永久性介入相关并发症。临床随访5个月～6年,患者无临床症状复发。结论多静脉途径介入栓塞是治疗海绵窦区硬脑膜动静脉瘘安全、有效的方法。     

经动脉途径栓塞海绵窦区硬脑膜动静脉瘘

目的 探讨经动脉途径介入栓塞海绵窦区硬脑膜动静瘘的疗效和策略.方法 回顾性分析经动脉途径介入栓塞治疗的19例海绵窦区硬脑膜动静脉瘘.结果 15例临床治愈,3例明显好转,1例治疗失败.其中术后即刻造影提示12例瘘口完全消失;6例经主要供血动脉栓寒后,经瘘口血流量明显减少,压颈1个月后5例临床治愈,1例症状明显缓解.经动脉治疗失败病例改经岩下窦入路双侧海绵窦微弹簧圈栓塞后治愈.无一例出现永久性介入相关并发症.临床随访7个月到4年,病人尤临床症状复发.结论 经动脉途径介入栓塞对于部分海绵窦区硬脑膜动静瘘的病人是安全、有效且经济的治疗方法 .     

海绵窦区硬脑膜动静脉瘘的治疗探讨

目的 探讨海绵窦区硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的治疗方法、效果及预后.方法 25例患者中8例行颈动脉压迫或仅随访观察;17例行血管内栓塞,其中3例经静脉途径栓塞,13例经动脉途径栓塞,其中1例联合使用覆膜支架和Glubran胶治疗,1例经动脉途径治疗后再次接受经静脉途径栓塞治疗.结果 8例行颈动脉压迫或随访观察的患者中有4例症状缓解或消失,其余患者无加重;3例经静脉途径栓塞者均通过同侧或对侧岩下窦入路完全闭塞瘘口;13例经动脉途径栓塞者中4例完全闭塞瘘口,其余患者症状部分缓解;1例患者首次经动脉途径部分栓塞术后症状加重,急诊经眼上静脉穿刺置管完全栓塞.结论 海绵窦区DAVF总体预后良好,可根据患者症状和影像学特征选择恰当的治疗方式,经静脉途径栓塞治愈率高,适宜者应作为首选治疗方法.     

经岩下窦介入栓塞海绵窦区硬脑膜动静脉瘘3例临床分析

目的 探讨经静脉人路栓塞治疗海绵窦区硬脑膜动静脉瘘的效果.方法 经股静脉-岩下窦入路到达病变侧海绵窦,用游离弹簧圈等多种栓塞材料填塞海绵窦,同时闭塞瘘口.结果 3例中全部愈或好转,1例在栓塞治疗后眼部症状消失.栓塞术后最常见症状为头痛伴呕吐.随访3个月到5年未见复发.结论 静脉入路栓塞治疗硬脑膜动静脉瘘是一种安全、有效的方法,应作为首选治疗方法.     

动脉入路ONYX栓塞治疗海绵窦区硬脑膜动静脉瘘的临床观察

目的探讨采用单纯动脉入路ONYX(医用胶)治疗在海绵窦区硬脑膜海绵窦瘘的意义及栓塞程度对预后的影响。方法回顾性分析2008—2010年我院行动脉入路ONYX治疗的10例患者的手术方式、术中栓塞程度、随访结果及临床意义,10例患者病变均为外伤性,均为择期手术,术中成功弥散ONYX胶,栓塞程度不同,术后随访至1年。结果 3例患者术后残留,行2期治疗,有7例ONYX胶弥散满意,术中造影无残留,分别于随访6个月、1年,3例残留者,瘘口较前分流增多,行2期治疗后,无残留。结论采用经动脉途径予以栓塞治疗的疗效已不容置疑,其优点在于:①可避免经静脉途径栓塞,正常静脉被误栓及栓塞后导致的出血。②术中观察,造影方便,射线量少。③动脉入路操作方便,适用于大多数患者,通过ONYX良好的弥散性能达到完全闭塞瘘口的目的而又不影响血液经静脉窦的正常回流,因此一般可以作为首选。     

侧窦区硬脑膜动静脉瘘的诊断与治疗

目的探讨侧窦区硬脑膜动静脉瘘的病因、发生机制、临床症状及诊治方法。方法１９例病人中,１７例病人应用微 导管技术,在数字减影血管造影机（ＤＳＡ）监视下,对侧窦区硬脑膜动静脉瘘行血管内栓塞治疗,２例单纯应用颈动脉压 迫法治疗。结果１９例中,１０例治愈;４例症状明显改善;４例好转;１例死亡。结论应用颈动脉压迫法及微导管栓塞技 术是治疗侧窦区硬脑膜动静脉瘘的有效手段。     

海绵窦区硬脑膜动静脉瘘影像学表现与栓塞治疗

海绵窦区硬脑膜动静脉畸形瘘（dural arterioveous fistula，DAVF）是指海绵窦区及其附近硬脑膜动静脉之间的异常交通，属脑血管畸形的一种，其临床表现、影像学表现及治疗均有其特点。本文报告13例DAVF病例的临床与影像学资料，并结合文献作一回顾性分析。     

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via

Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.     

Transvenous treatment of a complex cavernous sinus dural arteriovenous fistula secondary to balloon embolization of a traumatic carotid-cavernous fistula

Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2- cyanoacrylate （NBCA）. The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.     

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via transvenous approach

Cavernoussinusduralarteriovenousfistulas (CSdAVFs)formacomplexcommunicationnetworkbetweenthecavernoussinus (CS)andtheduralbranchesoftheexternalcarotidartery (ECA)and/orinternalcarotidartery (ICA) CSdAVFsusuallybecomesymptomaticspontaneouslyandoccurmostofteninelderlywomen TheclinicalmanifestationsofCSdAVFsdependonthepatternofvenousdrainage Chemosis ,conjunctivalcongestion ,bruit,ophthalmoplegia ,eyelidswelling ,proptosis,diplopia ,andvisualacuityimpairmentmayallresultfromCSdAVFs 1 …     

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases

Background  Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.
Methods  From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.
Results  All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.
Conclusions  Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

     

显微外科手术与血管内栓塞治疗硬脊膜动静脉瘘临床疗效比较的meta分析

目的: 通过meta分析比较显微外科手术与血管内栓塞治疗硬脊膜动静脉瘘的临床疗效。方法: 计算机检索PubMed、Embase、Web of Science、Cochrane临床试验数据库、中国知网、万方数据库、中国生物医学文献数据库(Chinese BioMedical Literature Database,CBM),检索时间从数据库建库至2019年12月,纳入采用显微外科手术和血管内栓塞治疗硬脊膜动静脉瘘的所有中英文文献。使用RevMan 5.3软件进行统计学分析,评估术后早期失败率、远期复发、神经功能恢复程度、并发症情况,比较两种治疗方式对硬脊膜动静脉瘘的临床疗效,并对血管内栓塞治疗进行亚组分析。结果: 纳入文献46篇,共1 958例硬脊膜动静脉瘘患者,其中935例采用显微外科手术治疗,1 023例采用血管内栓塞治疗,漏斗图显示未见明显发表偏倚。经meta分析结果显示,显微外科手术早期治疗失败的发生率低于血管内栓塞治疗(OR=0.20, 95%CI: 0.13~0.30, P<0.05),远期复发率也低于血管内栓塞治疗(OR=0.36, 95%CI: 0.22~0.58, P<0.05),显微外科手术治疗后患者神经功能改善情况优于血管内栓塞治疗的患者(OR=2.86, 95%CI: 1.36~5.99, P<0.05),两种治疗方式患者并发症的发生率差异无统计学意义(OR=1.52, 95%CI: 0.88~2.64, P=0.14)。血管内栓塞治疗的患者中,使用Onyx胶进行栓塞比使用α-氰基丙烯酸正丁酯(n-butyl 2-cyanoacrylate,NBCA胶)有更高的治疗失败或复发风险,差异有统计学意义(OR=4.70, 95%CI: 1.55~14.28, P<0.05)。结论: 虽然血管内栓塞治疗硬脊膜动静脉瘘的应用日趋广泛,但显微外科手术所获得的临床疗效仍明显优于血管内栓塞治疗。     

Transvenous injection of n-Butyl cyanoacrylate combined with placement of coils in cavernous sinus for treatment of cavernous dural arteriovenous fistulae

Objective： To evaluate the technical aspects, efficacy and safety in the treatment of cavernous dural arteriovenous fistulae （DAVF） by transvenous liquid n-Butyl cyanoacrylate （NBCA） injection combined with coils placement in the cavemous sinus. Methods： Eight patients with cavernous DAVF, treated by transvenous embolization with combination of detachable coils and glue between February 2006 and February 2009 in our hospital, were retrospectively analyzed, including the clinical presentations, patterns of angioarchitecture, methods of treatment and the results of follow-up. Results： In all 8 patients, 9 transvenous and 1 transarterial interventions were carried out. A single endovascular procedure was performed in 6 patients and 2 patients had to be treated twice. Of the nine transvenous approaches, eight approaches were performed via inferior petrosal sinus （IPS） and 1 via the facial vein. Complete angiographic obliteration was achieved in all patients immediately after the embolization. There was no procedure-related morbidity except for mild headache for one to seven days after the embolization. Clinical cure was achieved in all cases during the clinical follow-up periods, ranging from 8 months to 3 years. The follow-up angiography periods averaged 6.6 months with a range of 5-9 months, in which no recurrence was observed. Conclusion： In this small series, embolization with combination of glue and detachable coils by transvenous approaches was a safe, effective and economical method for the treatment of part of symptomatic patients presenting with complex cavernous DAVE     

Transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes

Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistula of cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results： Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete anglographic obliteration was documented in 22 patients （82%）. Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization. There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion： Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.