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。

Endovascular Therapy of Direct Carotid Cavernous Fistulas

To investigate the value of endovascular therapy in the treatment of direct carotid cavernousfistula. Materials and methods: Preembolization cerebral angiographies were carried out in 38 cases ofdirect carotid cavernous fistula. All patients were treated with detachable balloons by transarterial route.Results: Thirty six of 38 cases were succeeded with the procedure at a successful rate of 95%. Amongthose 36 cases, 34 of were completely obliterated, internal carotid ateries were preserved in 32. Onlyfour cases were undrgone internal carotid obliteralion. Signs and symptoms of those 36 patients werereleaved after treatment. Three paients undergone detachable balloon emboization by transvenousroue, were all failed due to partitions in the cavernous sinuses. Two patients suffered from aphonia andhemiplegia after the procedures due to early detachment and shifting of the balloons into branches ofmiddle cerebral atery. Conclusion: Endovascular embolization, especially transarterial detachable balloon embolization, presented a high rate of fistula bolitetation for direct carotid carernous fistula withlow mortality, and was considered to be the best initial treatment for direct carotid cavernous fistulas.