外伤性颈内动脉海绵窦瘘的血管内治疗

目的:总结应用多种血管内技术治疗外伤性颈内动脉海绵窦瘘(TCCF)的经验体会。方法:自2003年11月~2007年11月收治TCCF 16例。14例患者单纯应用可脱球囊治疗,1例应用可脱弹簧圈结合NBCA栓塞治疗,1例患者应用可脱球囊治疗失败后应用了覆膜支架治疗。结果:14例应用球囊成功栓塞瘘口,另2例分别应用可脱弹簧圈结合NBCA和覆膜支架最终治疗成功。14例闭塞瘘口并保留了颈内动脉,2例闭塞瘘口的同时闭塞了颈内动脉。无死亡以及手术相关性并发症。随访6~24个月(平均18个月),无1例复发。结论:多种血管内技术可以安全、有效地治疗外伤性颈内动脉海绵窦瘘。首选球囊闭塞瘘口,在球囊闭塞瘘口失败时可考虑应用可脱弹簧圈或覆膜支架。     

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。     

直接型颈动脉海绵窦瘘的血管内治疗

探讨血管内治疗对直接型颈动脉海绵窦瘘的价值。材料和方法：38例患者在治疗前均行脑血管造影检查，所有病例均采用经动脉途径，用可脱球囊导管进行栓塞治疗。结果：38例患者中有36例栓塞成功，其中34例患者瘘口完全闭塞。36例患者中有32例于栓塞后保留颈内动脉，4例行颈内动脉球囊闭塞术。术后36例患者的海绵窦综合症均有不同程度的好转。3例患者曾行经静脉途径可脱球囊栓塞治疗，但由于海绵窦内分隔的阻挡作用，球囊不能进入海绵窦及其瘘口附近而告失败。2例患者由于球囊早脱并移位于大脑中动脉分支血管内，导致患者发生失语和一侧肢体偏瘫。结论：血管内可脱球囊栓塞治疗直接型颈脉海绵窦瘘，其瘘口闭塞率高，死亡率低，是直接型颈动脉海绵窦瘘的首选治疗手段。     

Willis覆膜支架在颈内动脉海绵窦瘘中的应用

目的 评价应用Willis覆膜支架治疗颈内动脉海绵窦瘘(CCF)的价值.方法 2014年1月至2015年7月本院采用Willis覆膜支架治疗CCF 7例,分析患者的临床资料和疗效.结果 7例患者共置入Willis覆膜支架7枚.均一次成功置入支架,术后即刻血管造影显示病变完全消失,责任动脉通畅.7例随访6例临床症状逐渐好转,无手术相关并发症,术后半年行全脑血管造影复查5例,结果显示病变消失,责任动脉均保持通畅.结论 Willis覆膜支架治疗CCF成功率高,疗效好,并发症少,可作为可脱球囊栓塞失败患者的替代治疗方法.但仍需更长期的随访和大样本多中心研究.     

血管内栓塞治疗颈内动脉海绵窦瘘

目的　探讨颈内动脉海绵窦瘘 (CCF)血管内栓塞治疗的效果。方法　 5例均经DSA全脑血管造影明确瘘口部位 ,采用可脱性球囊或电致血凝性可脱性铂金弹簧圈 (GDC)进行栓塞。结果　 5例中 ,1例球囊栓塞成功并保持颈内动脉通畅 ;2例表现为假性动脉瘤 ,用球囊闭塞患侧颈内动脉 ;1例因瘘口太小 ,用GDC填塞海绵窦 ;另 1例 2次试放球囊入海绵窦均破裂失败 ,其中 1枚瘪陷球囊滞留于海绵窦 ,患者不愿闭塞患侧颈内动脉未予进一步治疗 ,但患者治疗术后 1周临床症状和体征消失。结论　颈内动脉海绵窦瘘全脑血管造影可明确瘘口部位、大小 ,首选治疗方法是血管内栓塞治疗。     

介入栓塞治疗外伤性颈动脉海绵窦瘘的疗效

目的 探讨介入栓塞治疗外伤性颈动脉海绵窦瘘(TCCF)的临床疗效及影像学变化。方法 选取77例TCCF患者的临床资料，按照不同的手术治疗方法分为球囊辅助弹簧圈栓塞(球囊辅助组35例、可脱性球囊栓塞(可脱性球囊组38例)、Willis覆膜支架栓塞(覆膜支架组4例),分析栓塞术后的影像学表现和预后。结果 77例患者共计手术84台次，行一次栓塞治疗70例，两次栓塞治疗7例。总体治愈率100%,颈内动脉通畅率97.4%。球囊辅助组与可脱性球囊组相比完全闭塞率、手术并发症发生率、一次性栓塞治愈率无明显差异。所有患者随访显示疗效可靠。结论 球囊辅助弹簧圈和可脱性球囊栓塞方法可作为治疗TCCF的首选方案，安全可靠。     

外伤性颈内动脉海绵窦瘘并严重鼻衄的血管内介入治疗

目的 探讨血管内介入治疗外伤性颈内动脉海绵窦瘘(TCCF)合并严重鼻衄的策略和疗效.方法 26例TCCF并严重鼻衄的患者进行了血管内介入治疗,其中24例采用了可脱性球囊栓塞瘘口或闭塞颈内动脉;1例采用解脱式微弹簧圈栓塞;1例采用覆膜支架进行治疗.结果 26例中,9例1次性栓塞了瘘口,假性动脉瘤消失,颈内动脉通畅;15例1次性栓塞了瘘口和闭塞颈内动脉;解脱式微弹簧圈栓塞海绵窦,瘘口基本消失,颈内动脉通畅1例;覆膜支架闭塞瘘口,颈内动脉保持通畅1例.术后26例均未再发生鼻衄.结论 TCCF并严重鼻衄应尽早进行DSA确诊,尽早或急症进行治疗.血管内介入治疗TCCF合并严重鼻衄是一种首选、安全和有效的治疗方法.     

外伤性颈内动脉海绵窦瘘的可脱性球囊栓塞治疗

目的 探讨外伤性颈内动脉海绵窦瘘(traumatic carotid -cavernous fistulas,TCCF)可脱性球囊栓塞术的技术要点并客观评价其治疗效果. 方法 以可脱性球囊栓塞治疗59例TCCF,共进行栓塞术64次.随访时间3个月～2年. 结果 48例成功闭塞瘘口且保留颈内动脉通畅,颈内动脉通畅率为81％;11例瘘口及颈内动脉被同时闭塞.5例在治疗后3d内复发(复发率为8％),再次行栓塞术,其中1例出现栓塞后失明,再次行球囊栓塞后成功闭塞,但视力未恢复;1例术后3d出现脑内血肿,急诊再次行栓塞,闭塞颈内动脉和瘘口,但左侧肢体轻瘫. 结论 以可脱性球囊栓塞是治疗TCCF的可靠方法,具有损伤小、安全性高的特点;术后应严密观察病情,若出现复发症状,应及时复查脑血管造影及头颅CT,急诊处理复发的TCCF.     

Detachable Balloon Embolization in Barrow Type A of Traumatic Carotid Cavernous Fistula

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.     

经动脉途径血管内治疗51例外伤性直接性颈动脉海绵窦瘘

目的推介最近5年经动脉途径使用可脱球囊、弹簧圈和Willis覆膜支架血管内治疗外伤性直接性颈动脉海绵窦瘘(TDCCFs)和保留颈内动脉(ICA)的经验。方法回顾性分析经动脉途径血管内治疗的51例患者的54处TDCCFs,均首选可脱球囊作为治疗方法,Willis覆膜支架和弹簧圈作为备选方法,术后3～48个月行脑血管造影和临床随访评价所有患者的治疗效果。结果一期单纯性可脱球囊成功治疗46处(85.2%)TDCCFs,并保留了ICA。使用可脱球囊、弹簧圈和Willis覆膜支架合计保留了53处(98.1%)TDCCFs的ICA,同时成功闭塞瘘口,仅1例闭塞了单侧ICA和瘘口。单纯可脱球囊治疗40处TDCCFs,单纯Willis覆膜支架治疗2处TDCCFs,单纯弹簧圈治疗1处TDCCF,可脱球囊联合Willis覆膜支架治疗8处TDCCFs,联合弹簧圈治疗3处TDCCFs,其中1处使用了Willis覆膜支架治疗。12处TDCCFs进行了二期和三期治疗。除外5例患者单侧视力损害和(或)脑神经麻痹无明显改善外,术后1 d～6个月其他病例症状呈阶梯型改善,直到消失。术中无一例患者血管破裂、无远端脑栓塞和新发神经系统症状等并发症...     

颈动脉海绵窦瘘的血管内栓塞治疗

目的　探讨不同的栓塞材料在颈动脉海绵窦瘘 (CCF)的血管内栓塞治疗中的应用。方法　回顾分析了 2 3例CCF血管内栓塞治疗病例。其中 2 2例外伤性CCF ,19例使用了可脱性球囊 ,3例使用了金属微弹簧圈作栓塞材料 ;1例自发性CCF ,使用了NB CA胶作栓塞剂。结果　可脱性球囊栓塞 19例 ,均获得临床治愈 ,其中 12例保持了患侧颈内动脉的通畅 ,获得解剖治愈 ;金属微弹簧圈栓塞 3例 ,2例成功 ,1例因弹簧圈异位栓塞于右大脑中动脉的分支 ,导致病人失语和半身不遂 ,1例自发性CCF ,经患侧脑膜副动脉注射NBCA胶 ,部分NBCA进入海绵窦内 ,病人获得临床治愈。结论　CCF首选血管内栓塞治疗 ,而可脱性球囊是一种理想的栓塞材料。由于金属微弹簧圈可控性差 ,不够安全 ,不应再被作为经颈内动脉途径的栓塞材料。     

Cerebrovascular occlusion by catheterization and embolization: clinical experience

Intravascular occlusion by various catheterization techniques was used to treat 27 cases of carotid-cavernous fistula, giant intracavernous aneurysm, and cerebral or dural arteriovenous malformation. Several case reports are presented. The detachable balloon technique proved valuable in the treatment of traumatic carotid-cavernous fistula and giant aneurysm. Calibrated-leak balloon catheterization with fluid embolization was used to treat cerebral arteriovenous malformation. Selection of embolic material is discussed.     

Carotid-cavernous fistula treated with detachable balloon during bilateral transcranial Doppler monitoring of middle cerebral arteries. A case report.

A traumatic carotid-cavernous fistula was closed with a silicone detachable balloon. Prior to the closure of the fistula, clinical and transcranial Doppler testing was performed in order to evaluate the consequences of a possible occlusion of the carotid artery. A newly developed Doppler technique with bilateral simultaneous velocity recordings of the middle cerebral arteries was useful during the procedure. The detachable balloon was effective in closing the fistula, but collapse of the balloon and the development of an extradural aneurysm was found at control examinations.     

Bilateral traumatic carotid-cavernous fistula treated using an inflatable and detachable balloon

The authors report a case of traumatic bilateral carotid-cavernous fistula successfully treated by inflatable and detachable balloon.     

Transarterial platinum coil embolization of carotid-cavernous fistulas

Of the 227 embolization procedures performed by our neurointerventional section for symptomatic carotid-cavernous fistulas over the past 10 years, five involved placement of platinum coils in the cavernous sinus from a transarterial route. In four patients, prior transarterial balloon procedures had failed to produce fistula closure. In the fifth patient, with Ehlers-Danlos syndrome, a prior transvenous embolization attempt was unsuccessful. In three patients, complete closure of the carotid-cavernous fistula was achieved with preservation of the parent artery. In one patient, the earliest treated, a portion of a platinum coil projected through the fistula into the parent artery. To eliminate the risk of clot formation and distal embolization, internal carotid occlusion was performed and tolerated without deficits. In the last patient, closure of the anterior drainage was achieved, but complicated by distal migration of the platinum coils with transient aggravation of ocular symptoms. Attempts to occlude the remaining cortical drainage were unsuccessful with platinum coils; therefore, a balloon was used to obliterate the small remaining fistula. Transarterial platinum coil embolization is an alternative treatment for symptomatic carotid-cavernous fistulas that cannot be closed successfully by other embolization techniques. The development of shorter, more thrombogenic, detachable or retrievable coils may make this technique more promising in the future.     

头颈部动静脉瘘的手术与栓塞治疗

目的：探讨头颈部动静脉瘘的手术及栓塞治疗效果。方法：回顾性分析74例头颈部动静脉瘘的手术与栓塞治疗;手术治疗14例其中颈动脉结扎2例、瘘口孤立5例、铜丝填塞6例、颅内眼上静脉夹闭1例;可脱球囊栓塞治疗60例。结果：手术治疗的14例,治愈6例,好转6例,复发1例,死亡1例;可脱球囊血管内栓塞治疗60例,治愈59例,好转1例。结论：头颈部动静脉瘘的治疗方法中,血管内栓塞应作为首选的治疗方法。     

Treatment of traumatic carotid-cavernous fistula using detachable balloon catheters

The goal of therapy in patients with traumatic carotid-cavernous fistulas is to occlude the fistula, preferably while maintaining the carotid blood flow. Surgical techniques that treat the fistula remote from the cavernous sinus often cannot maintain carotid patency. Various interventional techniques using detachable balloons have been developed. The most common technique uses the endarterial route, introducing the balloon catheter in the neck or the groin. If the balloon is detached in the cavernous sinus, the carotid blood flow will be preserved. A second approach uses the venous retrograde route through the jugular vein, inferior petrosal sinus, and cavernous sinus. Elegant and safe, this method is appropriate when the fistula drains posteriorly. A third approach involves surgical exposure of the cavernous sinus and direct introduction of the balloon. This is sometimes the only recourse when the fistula has been previously treated with internal carotid ligation.     

Transarterial embolization of a direct carotid cavernous fistula with Guglielmi detachable coils.

Four patients underwent transarterial embolization of a carotid-cavernous fistula with Guglielmi detachable coils; in three cases as the initial form of treatment and in one case after treatment via transarterial balloon embolization failed. The fistulas were 2 to 3 mm in diameter on pretreatment angiograms. Complete obliteration was achieved in two patients; in the other two, minimal residual flow remained immediately after embolization but disappeared by follow-up angiography. One to four coils were used to occlude the fistulas. The internal carotid artery remained patent in all patients, and there were no complications.