外伤性颈动脉海绵窦瘘的血管内治疗及并发症防治

目的探讨血管内栓塞治疗外伤性颈动脉海绵窦瘘（TCCF）的技术要点、并发症及其防治经验，并客观评价其治疗效果。方法56例TCCF患者中54例采用股动脉穿刺入路，另2例采用股静脉-岩上窦入路行海绵窦内栓塞；56例中49例采用可脱性球囊栓塞，2例采用微弹簧圈栓塞，5例采用可脱性球囊加微弹簧圈栓塞。结果49例成功闭塞瘘口且保留颈内动脉（ICA）通畅；7例瘘口及ICA被同时闭塞。本组ICA通畅率为87．5％，无手术死亡，治愈率为100％。随访4个月～12年，均无瘘口再通，术后除1例患眼永久性失明外，病情均恢复良好，无脑缺血及脑梗塞等并发症。结论经动脉入路用可脱性球囊栓塞是治疗TCCF的首选方法，小瘘口TCCF可选择微弹簧圈栓塞；血管内栓塞治疗TCCF疗效可靠。

Treatment of traumatic carotid cavernous fistula by endovascular embolization and the cure and prevention of its complications

Objective To explore the treatment of traumatic carotid cavernous fistula （TCCF） by endovascular embolization and its curative efficacy. Methods Among 56 patients with TCCF, 54 cases were embolized by puncture via femoral route and 2 cases via the femoral vein and superior petrous vein route. For the embolization materials, balloons were used in 49 cases, microcoils were used in 2 cases, and both two materials in 5 cases. Results The fistulae of 49 cases were occluded with the patency of parent arteries and internal carotid artery （ICA）. Both fistulae and ICA were occlued in 7 cases. The rate of ICA patency was 87.5%. No dead case due to surgical treatment. The total success rate was 100%. None of the carotid cavernous fistula recurred during the follow-up from 4 months to 12 years. The symptoms and signs of all patients disappeared remarkably except for 1 case of eyesight perpetual ablepsia after the embolization. No cerebral iscbemia and infarction occurred during the follow-up. Conclusion The endovascular embolization by artery route has become the most effective method for the treatment of TCCF, but detachable balloon should be the first choice. For small fistula, microcoil embolization is a better choice. The results of endovaaeular embolization are reliable for the treatment of TCCF.