岩下窦的DSA图像分析对血管内治疗颈动脉海绵窦瘘的指导价值

目的分析颈动脉海绵窦瘘(CCF)患者岩下窦(IPS)的DSA图像,探讨其对血管内治疗CCF的指导价值。方法选择福建医科大学福总临床医学院(第九〇〇医院)神经外科自2013年1月至2019年12月采用血管内治疗的76例CCF患者,回顾性分析患者的手术过程及全脑DSA图像。依据Barrow分型将患者分为直接CCF组(52例)、间接CCF组(24例)。比较2组患者患侧IPS的显影情况,比较IPS全程显影患者中直接CCF、间接CCF患者IPS汇入颈内静脉(IJV)的位置,分析经IPS行血管内治疗CCF的疗效。结果间接CCF组患者中IPS显影不良者所占比例(45.8%,11/24)明显高于直接CCF组(17.3%,9/52),差异有统计学意义(P<0.05)。IPS全程显影的56例CCF患者中,除1例患者IPS直接汇入椎静脉丛(VVP)而与IJV无连接外,直接CCF组、间接CCF组患者中IPS颅内汇入者所占比例差异无统计学意义(P>0.05)。24例间接CCF患者均首选经IPS栓塞,其中13例IPS全程显影者超选时均比较顺利(开通率为100%),微导管到位耗时较短(平均32 min);11例IPS显影不良的患者术中使用泥鳅导丝引导以及微导丝成袢技术成功开通5例(开通率为45%),微导管到位耗时较长(平均69 min)。结论间接CCF有较高的IPS闭塞率,造影侧位及3D成像可见IPS与颈内动脉岩骨段呈近似平行关系,掌握IPS的走行及其末端汇入IJV的位置关系,对于经静脉途径将微导管通过显影不良的IPS进入海绵窦进行介入栓塞具有非常重要的指导价值。

Value of inferior petrosal sinus digital substraction angiography analysis in endovascular treatment of carotid cavernous fistulas

Objective To analyze the digital substraction angiography(DSA)features of inferior petrosal sinus(IPS)in patients with carotid cavernous fistulas(CCF),and explore its guiding value in endovascular treatment of CCF.Methods The surgical process and whole brain DSA images of 76 CCF patients accepted endovascular treatment in our hospital from January 2013 to December 2019 were retrospectively analyzed.These patients were divided into direct CCF group(n=52)and indirect CCF group(n=24)according to the Barrow typing.The development of IPS in the affected side of the 2 groups was compared,and the location of IPS entry into the internal jugular vein(IJV)in patients from direct CCF group and indirect CCF group during the whole process of IPS development was compared,and the efficacy of endovascular treatment of CCF by IPS was analyzed.Results Indirect CCF group had significantly higher proportion of patients with poor visualization(45.8%,11/24)as compared with direct CCF group(17.3%,9/52,P<0.05).Except one patient with IPS not connecting to IJV,the proportion of intracranial IPS-IJV junction showed no significant difference between the two groups(P>0.05).IPS embolization was the first choice for all the 24 indirect CCF patients:13 patients with IPS whole-process development had a relatively smooth superselecative cathelerization(reperfusion rate=100%),and the time of microcatheter placement was relatively short(32 min on average);in the 11 patients with poor IPS development,5 were successfully opened by loach guidewire guidance and microguide wire looping technique(reperfusion rate=45%),and microcatheter placement was relatively long(69 min on average).Conclusions Indirect CCF has a high rate of IPS occlusion.Lateral and 3D images show that IPS is parallel to the petrous bone segment of internal carotid artery.Mastering the course of IPS and the location of its terminal into IJV has very important value for guiding the microcatheter to enter the cavernous sinus through the poorly visualized IPS.