经动脉入路Onyx栓塞海绵窦区硬脑膜动静脉瘘

目的经动脉入路以Onyx栓寨海绵窦区硬脑膜动静脉瘘（CSDAVF）的疗效观察。方法同顾性分析2006年5月-2010年5月在第二军医大学长海医院神经外科经动脉入路栓塞治疗的CSDAVF患者10例，其中女8例，粥2例，Borden分型I型2例，Ⅱ型8例？均在全身麻醉下以Onyx-18栓塞治疗。结果①10例患者共进行11次介入治疗，8次术中即刻被完全栓塞，3次被部分栓塞，其中1例第2次治疗时被完全栓塞，2例被部分栓塞的患者随访造影显示完全栓寒：共经14支供血动脉栓塞，其中咽升动脉5次，脑膜中动脉3j欠，脑膜副动脉5次，眼动脉脑膜返动脉1次。平均注胶时间为32．9min（10～63min），注胶量为1．8ml（0．8～3．1ml）：②平均随访27个月（4～51个月）。患者症状均有好转：被完全栓塞的患者术后即刻颐内杂昔消失，球结膜充血、眼球突出在术后1周内消失，复视和视力下降症状在术后1～3个月内好转；被部分栓塞的3例患者术后即刻杂音减轻，3个月后完全消失，眼部症状在3个月后完全消失。⑧1例BordenⅡ型患哲在被部分柃塞后3．5年发生颅内出血，第2次术后随访7个月，未见再出血和眼部症状；2例术中Onyx弥散至颈内动脉系统，1例出现永久性脑神经麻痹。结论采用Onyx经动咏入路栓塞可以有效地治疗CSDAVF，但应注意避免危险吻合栓塞带来的并发症。

Transarterial embolization of carvernous sinus dural arteriovenous fistulas with Onyx

Objective To observe the efficacy of transarterial embolization of cavernous sinus dural arteriovenous fistulas （CSDAVFs） with Onyx. Methods Ten patients with CSDAVFs （8 females and 2 males） embolized transarterially from May 2006 to May 2010 in Changhai Hospital, the Second Military＇ Medical University were analyzed retrospectively. Two were Borden type I and 8 were Borden type II according to the drainage patterns. They were all embolized with Onyx under general anesthesia. Results （1）Eleven inter- ventional therapeutic procedures were performed in the 10 patients, 8 procedures achieved immediate eomplete embolization, and 3 were partially embolized, and one of them aehie~ed complete embolization alter the second procedure. Follow-up angiography showed complete occlusion in the 2 patients of partial embolization. A total of 14 feeding arteries were embolized, including 5 ascending pharyngeal arteries, 3 middle meningeal arteries, 5 accessory meningeal arteries, and 1 refluent meningeal artery, arising from the ophthalmic artery. The mean time of injecting Onyx was 32.9 rain （ 10 - 63 min）, and the volmne of injecting Onyx was 1.8 mL （0.8 -3.1 mL）. （2）The men fullow-up period was 27 （4 to 51 ） months. The symptoms of patents were all improved. The intraeranial bruit disappeared immediately after the procedure in patients of complete embolization. Conjunctival hyperemia and exophthahnos disappeared within 1 week after theprocedure, and the symptoms of diplopia and decreased visual acuity improved within 1 to 3 months after the procedure. The intracranial bruit and the eye symptoms in the 3 patients of partial embolization was alleviated immediately after the procedure, and completely disappeared after 3 months. （3）One patient of Borden II type occun＇ed intracranial hemorrhage 3.5 years after partial embolization, no rebleeding and eye symptom were found after the second procedure during follow-up for 7 months. Onyx dispersed into internal carotid artery, system in 2 patients during the procedure, and one patient had permanent cranial nerve palsy. Conclusion Transarterial embolization with Onyx may effectively treat CSDAVFs, however, It shouht be take care to avoid the complications caused by risk anastomotic embolization.