血管内介入治疗外伤性颈动脉-海绵窦瘘存在的问题

目的总结血管内介入治疗外伤性颈动脉一海绵窦瘘(TCCF)中存在的一些问题，探讨避免引起这些问题的技术方法。方法以可脱性球囊栓塞治疗68例TCCF患者，共进行栓塞术75次。1例经颈部切开穿刺，以球囊栓塞；2例经眼静脉入路以微弹簧圈栓塞海绵窦，其余则经股动脉入路栓塞。结果颈内动脉通畅率为66．2％，有3例在瘘口近端闭塞颈内动脉，有5例在栓塞术后3d内球囊过早泄漏，再次行栓塞术，1例栓塞瘘口后出现假性动脉瘤，1例出现眼静脉的动静脉瘘。结论以可脱性球囊栓塞TCCF是可靠的方法，但目前球囊的性能有待提高，以微弹簧圈栓塞海绵窦瘘可提高颈内动脉通畅率．双侧股动脉穿刺置管可减少并发症。

Problems in endovascular treatment of traumatic carotid-cavernous fistulas

Objective To state the problems including the difficulties and complications met during endovascular treatment of traumatic carotid-cavernous fistulas (TCCF), and to discuss the technical methods to avoid the problems. Methods 68 patients of TCCF were treated with detachable balloons, with 75 procedures. In 1 patient, the balloon occlusion was performed via direct carotid puncture in the neck. In 2 cases, the cavernous sinus and the fistulas were embolized with coils through the ophthalmic vein after balloon embolization failed, while the others were performed via femoral artery puncture. Results After treatment, 66. 2% of the internal carotid arteries (ICA) remained patent. In 3 cases, the ICAs were occluded proximal to the fistulas. In 5 cases, the balloons leaked within 3 days after embolization, and were successfully embolized again. There was one case of pseudoaneurysm formed near the fistula, and one case of ophthalmic vein arteriovenous fistula. Conclusion Embolization of TCCF with balloon is a reliable therapeutic method. However, the quality of the balloon needs to be improved. Embolization of TCCF with coils can improve the patent rate of the ICA. Bilateral transfemoral puncture is necessary to reduce complication.