海绵窦区硬脑膜动静脉瘘的诊断与治疗

目的:探讨海绵窦区硬脑膜动静脉瘘(CSDAVF)的诊断及治疗.方法:CSDAVF患者15例,均经全脑血管造影证实,1例行颈动脉压迫,14例行血管内栓塞,其中9例经静脉途径,3例经动脉途径,2例经动脉和静脉途径联合栓塞.结果:3例单纯颈外动脉供血患者经动脉途径栓塞术后复查2例治愈,1例部分栓塞,眼部症状明显改善;经静脉途...     

海绵窦区硬脑膜动静脉瘘1例

海绵窦区硬脑膜动静脉瘘(dural arteriovenous fistulainVoIving the cavernous sinus,CDAVFs)是硬脑膜动静脉瘘(DAVF)的一种类型,因病情复杂,早期诊断困难,临床误诊率高,治疗上有一定困难.本文报道1例海绵窦区硬脑膜动静脉瘘,并复习相关文献.     

经静脉途径栓塞海绵窦区硬脑膜动静脉瘘--附22例报告

目的:探讨经静脉途径栓塞治疗海绵窦区硬脑膜动静脉瘘的疗效.方法:对22例海绵窦区硬脑膜动静脉瘘患者行经静脉途径栓塞治疗,通过脑血管造影及临床随访来评价临床疗效.结果:术后即刻造影示瘘口完全闭塞12例,瘘口处血流速度明显减慢10例.9例患者术后第2日出现眼球水肿一过性加重,经脱水等治疗后症状缓解.随访3个月～2年,临床症状消失14例,症状明显缓解8例.结论:经静脉途径栓塞治疗海绵窦区硬脑膜动静脉瘘对部分患者是一种有效的治疗方法.     

海绵窦区硬脑膜动静脉瘘38例分析

目的：探讨海绵窦区硬脑膜动静脉瘘的病因、发生机制、临床特点。方法：采用Sendelinger技术,对硬脑膜动静脉瘘行血管内栓塞,本组用PVA及干冻硬膜等微粒栓塞15例,NBCA胶栓塞6例,PVA或干冻硬膜与NBCA胶联全栓塞5例,可脱性球囊栓塞2例,用弹簧栓塞5例,颈动脉压迫法治疗5例,结果：单纯颈外动脉及颈内动脉供血者24例,其中16例栓塞治愈,2例经1次,2例经2次栓塞后症状好转,但仍有轻度颅内杂音,单纯压迫颈动脉法治愈4例,颈内外动脉分支同时供血的14例,7例颈外动脉栓塞结合颈动脉压迫法治愈,3例症状明显改善,3例症状好转,1例单纯压迫颈动脉治愈,结论：血管内栓塞治疗海绵窦区硬脑膜动静脉瘘是一种安全、可靠的治疗方法。     

海绵窦区硬脑膜动静脉畸形影像学与栓塞治疗研究

目的 探讨DAvF的影像学表现及血管内栓塞治疗方法。方法 13例均行Cr、MRI及血管造影检查。治疗采用微导管超选择性插管，经微导管注入微粒，栓塞供血动脉及瘘口，4例并经岩上、下窦用钨丝螺旋困行海绵窦内栓塞。结果 血管造影可显示供血动脉及引流静脉。13例瘘口均闭塞，随访3mo-8a无再通。结论 血管造影为研究本病的重要手段，血管内栓塞是治疗影像DAVF的有效方法。     

颈内动脉海绵窦瘘及硬脑膜海绵窦瘘10例临床分析

目的：总结颈内动脉海绵窦瘘及硬脑膜海绵窦瘘的眼部表现、影像学特点及治疗方法。方法：收集10例颈内动脉海绵窦瘘及硬脑膜海绵窦瘘患者的临床资料进行分析。结果：眼部表现包括眼球突出、球结膜血管充血怒张、眼底改变、眼外肌麻痹、眼压升高、视力下降等。CT和MRI检查可见眼上静脉扩张和海绵窦增宽，上、下、内、外直肌增粗。彩色多普勒超声检查可见眼上静脉扩张，且为动脉性频谱血流信号。数字减影血管造影显示患眼侧脑实质血液灌注减少，颈内动脉扩张，海绵窦段可见瘘口位置。除1例硬脑膜海绵窦瘘患者放弃治疗外，其余患者接受了可脱球囊或微弹簧丝血管内栓塞治疗。术后所有患者眼球突出程度较术前减小，结膜水肿明显减轻或消失，眼球运动正常或眼球运动障碍明显缓解，有视力轻度下降的4例患者视力恢复至发病前水平。随访3～24个月，患者均未再出现上述临床症状。结论：眼球突出，球结膜血管充血、怒张是颈内动脉海绵窦瘘及硬脑膜海绵窦瘘患者常见的眼部表现。结合影像学检查有利于早期诊断，而血管内栓塞创伤性小、效果可靠，是治疗颈内动脉海绵窦瘘及硬脑膜海绵窦瘘的有效方法。     

颈内动脉海绵窦瘘的栓塞治疗

目的　进一步探讨颈内动脉海绵窦瘘 (CCF)血管内栓塞治疗的方法及临床价值。方法　在DSA监视下 ,采用法国Balt公司的同轴可脱性球囊技术 ,对 12例CCF患者进行了可脱性球囊栓塞治疗。结果　一次完全性地栓塞了颈内动脉瘘口 ,又保持了颈内动脉通畅 ,大脑前、中动脉显示清晰者 11例 ,占 92 % ;术后临床症状和体征完全消失。结论　采用可脱性球囊血管内栓塞是治疗CCF的最好方法 ,其操作简单 ,安全可靠 ,疗效好 ,值得进一步推广。     

静脉入路血管内治疗海绵窦区硬脑膜动静脉瘘11例围手术期护理

目的 探索经静脉入路血管内治疗海绵窦区硬脑膜动静脉瘘的围手术期护理。 方法 对11例海绵窦区硬脑膜动静脉瘘患者经静脉入路行血管内栓塞治疗;术前做好眼部护理、心理护理、生活护理,术后密切观察病情变化及并发症的护理。 结果 11例均达到临床治愈,随访6月~3年,无复发及加重。 结论 经静脉入路血管内治疗海绵窦区硬脑膜动静脉瘘效果良好,有效的术前术中术后护理配合在治疗海绵窦区硬脑膜动静脉瘘过程中起着非常重要的作用,能减少并发症的发生,提高治愈率。     

外伤性硬脑膜动静脉瘘血管内栓塞治疗的护理

总结3例外伤性硬脑膜动静脉瘘血管内栓塞治疗的护理体会,认为重点是在栓塞治疗前作好健康宣教及体位训练,栓塞治疗后做好并发症的观察与护理.3例行栓塞治疗均顺利,术后1周出院.随访3月至3年,无复发病例,视力和语言功能正常.     

Xper-CT Guide引导下眼上静脉穿刺术在海绵窦区硬脑膜动静脉瘘栓塞中的运用

目的 探讨飞利浦DSA血管机中Xper-CT Guide 导航穿刺软件引导下眼上静脉穿刺术在海绵窦区硬脑膜动静脉瘘栓塞术中指导作用和应用价值。 方法 回顾性分析2017年8月至2019年12月收治的3例海绵窦区硬脑膜动静脉瘘患者经Xper-CT Guide 导航穿刺软件引导下直接经眼上静脉入路穿刺海绵窦。 结果 3例患者均穿刺成功,成功率为100%,一次性栓塞治愈海绵窦区硬脑膜动静脉瘘。 结论 Xper-CT Guide引导下眼上静脉穿刺术成功率高,可精准辅助手术医生经眶穿刺眼上静脉,指导手术路径,在复杂的海绵窦区硬脑膜动静脉瘘栓塞治疗中有一定的临床应用价值。     

Treatment of cavernous sinus dural arteriovenous fistula using different surgical approaches: Analysis of 32 consecutive cases

ObjectiveTransarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula (CSDAVF). Here., we report the angioarchitectural features and clinical outcomes of CSDAVF in patients treated with either the inferior arterial approach (IAA) or the inferior petrosal sinus approach (IPSA).MethodsThe clinical data of 32 patients with CSDAVF treated at our institution from May 2008 to May 2014 were retrospectively analyzed. All patients underwent routine diagnostic digital subtraction angiography (DSA) before surgery. Embolization was performed using the IPSA through the internal jugular vein or IAA, based on angioarchitectural features.ResultsOf the 32 patients with CSDAVF, 24 underwent embolization treatment through the internal jugular vein-IPSA and 8 patients underwent treatment through IAA. Nineteen patients in the IPSA group experienced mild headache, which improved after specific treatment. The immediate postembolization angiographic results revealed complete occlusion in 26 cases (18 IPSA and 8 IAA) and almost complete occlusion in 6 cases (IPSA). Complications that occurred during the procedure included abducens nerve palsy (n = 1, IPSA) and prosopoplegia (n = 1, IAA). One patient developed tinnitus, which was diagnosed as anterior cranial fossa new-onset dural arteriovenous fistula on DSA, whereas the symptoms of other patients all improved with no recurrence.ConclusionsOn the basis of the angioarchitectural features of CSDAVF, IAA can be considered the primary treatment when the blood-supplying artery and fistula are relatively singular, and when the microcatheter can easily reach the fistula through the artery. The venous approach should be selected as the primary approach when the fistula is indistinguishable and blood is supplied by multiple arteries through small plexiform vessels. Choosing the optimal surgical approach may increase the success rate of intravascular CSDAVF surgery and may help avoid complications.     

Transvenous embolization of cavernous sinus dural arteriovenous fistula through a thrombosed inferior petrosal sinus utilizing 3D venography

Objective

We report a new technique in approaching the cavernous sinus through an occluded inferior petrosal sinus (IPS) using three-dimensional (3D) venography.

Case presentation

A patient diagnosed with arteriovenous fistula of the right cavernous sinus underwent transvenous embolization. The IPS was not detectable on angiogram. Retrograde injection of contrast with 3D imaging of the internal jugular vein clearly demonstrated the remnant of the IPS. By referring to the images obtained, catheterization of the cavernous sinus by way of the IPS was performed without difficulties.

Conclusion

Three-dimensional venography for detecting the entrance to the IPS is a useful method and easy to perform. We believe that this technique should be considered whenever the access to an occluded IPS is necessary.     

Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas

Objective

To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques.

Methods

One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils.

Results

Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas.

Conclusion

Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.     

Transforaminal approach for cerebral dural arteriovenous fistula embolization

A transverse sinus dural arteriovenous fistula (DAVF) not easily accessible by standard transfemoral (transarterial or transvenous) endovascular approaches is presented. An enlarged transosseous retromastoid foramen harboring the occipital artery branch feeding the lesion was identified on CT angiogram (CTA). Curative Onyx embolization was achieved via percutaneous CT-guided direct puncture of the transosseous occipital arterial branch followed by microcatheter navigation through the needle distally towards the site of the fistula.     

Vessel wall MRI in ruptured cranial dural arteriovenous fistulas

Intracranial high-resolution vessel wall MRI (VW-MRI) is an imaging paradigm that is useful in site-of-rupture identification in patients presenting with spontaneous subarachnoid hemorrhage and multiple intracranial aneurysms. Only a handful of case reports describe its potential utility in the evaluation of more complex brain vascular malformations. We report for the first time three patients with ruptured cranial dural arteriovenous fistulas (dAVFs) that were evaluated with high-resolution VW-MRI. The presumed site-of-rupture was identified based on contiguity of a venous ectasia with adjacent blood products and thick, concentric wall enhancement. This preliminary experience suggests a role for high-resolution VW-MRI in the evaluation of ruptured cranial dAVFs, in particular, site-of-rupture identification. It also supports an emerging hypothesis that all spontaneously ruptured, macrovascular lesions demonstrate avid vessel wall enhancement.     

Efficacy of a unique straight,conformable, bare platinum coil in the treatment of cavernous sinus dural arteriovenous fistula

In embolization of a cavernous sinus (CS) by transvenous embolization (TVE) for a CS dural arteriovenous fistula (DAVF), selection of embolization coils is difficult owing to the complex anatomical structure of the CS. Moreover, overpacking of the CS with embolization coils may cause permanent cranial nerve palsies. The ED coil-10 (EDC-10) infini is an extremely soft platinum coil without shape-memory that has excellent conformability with surrounding structures. The goal of this study was to evaluate use of the EDC-10 infini coil for embolization of a CS DAVF.Six patients with a CS DAVF were treated with TVE. Refluxing cerebral and ophthalmic veins were embolized with shape-memory type coils other than EDC-10 infini, and CSs were embolized with the EDC-10 infini coils. In five cases, CSs were loosely embolized with EDC-10 infini coils. In one case, reflux of the cerebral vein worsened from the CS during the procedure, and embolization of the CS tightly using three-dimensional shape-memory type coils other than EDC-10 infini. Overall, three to 19 (average 7.3) coils were used fozr each CS and the total coil volume was 33–284 (average 95.1) mm³ in each CS. Postoperative transient abducens palsy occurred in two cases, but both patients recovered completely. There was no case of recurrence.The EDC-10 infini coil showed excellent conformability with the complex inner structure of the CS and excellent safety without postoperative permanent cranial nerve palsy.     

Complex spinal arteriovenous fistula of the craniocervical junction with pial and dural shunts combined with contralateral dural arteriovenous fistula

A high cervical dural arteriovenous fistula (dAVF) is relatively rare and tends to have different features, as compared with a thoracolumbar dAVF. Here, we report a case involving a complex AVF located at the craniocervical junction that was fed by the dural and pial arteries, combined with a contralateral dAVF.     

Xper Guide引导下眼上静脉穿刺术在海绵窦区硬脑膜动静脉瘘栓塞中的应用

目的：探讨飞利浦DSA血管机中Xper Guide导航穿刺软件引导下眼上静脉穿刺术在海绵窦区硬脑膜动静脉瘘栓塞术中的指导作用和应用价值。方法：回顾性分析2017年8月至2019年12月武汉大学中南医院收治的3例海绵窦区硬脑膜动静脉瘘患者的病例资料，均行Xper Guide导航穿刺软件引导下直接经眼上静脉入路穿刺海绵窦。结果：3例患者均穿刺成功，一次性栓塞治愈海绵窦区硬脑膜动静脉瘘。结论：Xper Guide引导下眼上静脉穿刺术可精准辅助经眶穿刺眼上静脉，指导手术路径，有一定的临床应用价值。     

彩色多普勒超声在颈内动脉海绵窦瘘诊断中的应用

目的　评价彩色多普勒超声 (CDFI)在颈内动脉海绵窦瘘 (CCSF)诊断及术后疗效观察中的应用价值。方法　应用CDFI对 2 7例疑为CCSF患者病变处进行观察 ,测量其大小、范围、血流频谱 ,对所有患者颅内、颈部及眼部血管进行探测 ,分别测量相关血流参数 ,并对 12例CCSF栓塞术后的患者随访观察 ,病例诊断均经脑血管造影证实。结果　①CDFI对CCSF病变部位的检出率为 96% ;②CDFI显示患侧前床突后下方出现不规则片状血流团影 ,与正常颈内动脉的横断面血流影相比差异有显著性意义 (1.7～ 3 .9cm2 vs 0 .2～ 0 .5cm2 ,P <0 .0 1) ;频谱多普勒呈多方向、不规则的湍流 ,速度 65～ 170cm /s ;③瘘口近端血管阻力减低 ,远端分支血管如大脑中动脉 (MCA)、大脑前动脉 (ACA)、眼动脉 (OA)等流速减低 (P <0 .0 5 ) ,眼上静脉 (SOV )检出具特征性的脉动样血流频谱 ,平均Vmax3 4.5cm /s ,阻力指数 0 .3 1± 0 .0 8;④ 12例CCSF栓塞术后的患者检出 8例完全栓塞 ,4例不完全栓塞。结论　结合二维超声显像、相关血管的血流动力学变化及眼上静脉的特征性改变 ,超声检查可诊断CCSF ,同时亦可准确反映栓塞效果     

Embolization of a superior sagittal sinus dural arteriovenous fistula under intrasinus balloon protection: A case report

Endovascular embolization has evolved to become the primary therapeutic option for dural arteriovenous fistulas (DAVFs). While guaranteeing complete occlusion of the fistula orifice, the goal of DAVF embolization is also to ensure the patency of normal cerebral venous drainage. This paper describes a case of successful embolization of a complex DAVF in the superior sagittal sinus with a multistaged approach using a combination of transvenous and transarterial tactics. The strategies and techniques are discussed.