头颈部少见类型动-静脉瘘的血管内栓塞治疗

目的探讨头颈部少见类型动-静脉瘘血管内栓塞治疗的方法及临床价值。方法创伤性伴有基底动脉动脉瘤的基底动脉-基底静脉丛瘘、原始三叉动脉动脉瘤破裂臻致三叉动脉-海绵窦瘘、自发性和创伤性颈外动脉-海绵窦瘘、创伤性颈内动脉-海绵窦瘘伴有椎动-静脉瘘及创伤性颈内动脉-海绵间窦瘘各1例，对此6例少见类型动-静脉瘘患分别采用机械解脱弹簧圈、电解脱弹簧圈以及可脱性球囊技术进行血管内栓塞治疗。结果创伤性伴有基底动脉动脉瘤的基底动脉-基底静脉丛瘘和创伤性颈内动脉-海绵窦瘘伴有椎动-静脉瘘患分两次伶塞，而原始三叉动脉动脉瘤破裂致三叉动脉-海绵窦瘘、自发性和刨伤性颈外动脉-海绵窦瘘、刨伤性颈内动脉-海绵间窦瘘患均一次完成栓塞治疗。手术后临床症状和体征完全消失。无并发症发生。结论血管内栓塞是治疗头颈部少见类型动-静脉瘘的最佳方法，其操作简单．安全可靠，疗效好，并发症发生率低。应作为首选。

Endovascular embolization treatment for unusual types of arteriovenous fistulas in head and neck

Objective To study the methods and clinical value of endovascular embolization for unusual types of intracranial arteriovenous fistulas in head and neck. Methods Six patients with various disorders: 1) traumatic basilar arteriovenous plexus fistula associated with basilar artery aneurysm,2)primitive trigeminal artery,cavernous sinus fistula resulted from ruptured aneurysm, 3)spontaneous external carotid artery,cavernous sinus fistula,4) traumatic external carotid artery,cavernous sinus fistula, 5)traumatic internal carotid artery,cavernous sinus fistula complicated with vertebral arteriovenous fistula and 6) traumatic internal carotid artery,intercavernous sinus fistula, were treated by endovascular embolization with mechanical detachable spiral (MDS), Guglielmi detachable coils (GDC) or detachable balloon. Results The patient with traumatic basilar arteriovenous plexus fistula associated with basilar artery aneurysm and another patient with traumatic internal carotid artery,cavernous sinus fistula complicated with vertebral arteriovenous fistula were received 2 step embolization treatment, the 4 remaining were performed one time embolization. Symptoms and signs were completely diminished postoperatively. Complications were not found in either patient. Conclusion Endovascular embolization is the optimal treatment for unusual types of intracranial arteriovenous fistulas. This apporach is reliable and safe, easy to perform, fewer complications, and favorably effective. Thus it is the first choice therapy for these patients.