静脉窦内球囊辅助Onyx18闭塞上矢状窦及侧窦治疗硬脑膜动静脉瘘

目的探讨静脉窦内球囊辅助栓塞剂——Onyx18闭塞上矢状窦及侧窦（横窦和乙状窦）治疗硬脑膜动静脉瘘（DAVF）的可行性、安全性和有效性。方法回顾性分析2008年2月—2012年6月,经静脉途径在静脉窦内使用保护球囊,经动脉和（或）静脉途径,采用Onyx18栓塞治疗上矢状窦区和侧窦区DAVF的24例患者的临床资料,分析球囊辅助栓塞的效果以及并发症的发生情况。结果①本组24例患者,病变位于上矢状窦区5例,侧窦区19例。对上矢状窦区病变和侧窦区病变使用Hyperform 7 mm×7 mm球囊各1例,对其余患者使用外周血管扩张用球囊。②对上矢状窦区病变的患者经动脉栓塞3例,经静脉栓塞2例,使用球囊均基本闭塞静脉窦;对侧窦区病变患者经动脉栓塞10例,经静脉栓塞7例,动静脉联合栓塞2例;使用球囊基本闭塞静脉窦8例,部分闭塞静脉窦11例。③上矢状窦病变患者3例栓塞后治愈,有2例随访半年无复发,1例栓塞后少量残余,1年后复查造影无明显变化;在侧窦区病变的患者中,对1例患者行两次栓塞后瘘口消失,其余患者均经1次栓塞治愈,对其中7例患者治疗后半年进行了血管造影随访,未见复发。结论对经严格选择适应证的DAVF患者在球囊辅助下使用Onyx18闭塞侧窦（横窦和乙状窦）和上矢状窦,治疗DAVF是一种相对安全、有效的方法,能最大程度地保留静脉窦的通畅性。

Efficacy analysis of balloon assisted with Onyx18 for embolization of superior sagittal sinus and lateral sinus in the treatment of dural arteriovenous fistula

Objective To investigate the reliability,safety and effectiveness of balloon-assisted with Onyx18 for embolization of superior sagittal sinus and lateral sinus(transverse sinus and sigmoid sinus) in the treatment of dural arteriovenous fistula(DAVF).Methods The clinical data of 24 patients using protection balloons via arterial and/or the intravenous approaches for the treatment of DAVF in superior sagittal sinus and lateral sinus with Onyx18 were analyzed retrospectively from February 2008 to June 2012.The results of balloon-assisted embolization and procedure-related complications were analyzed.Results ①Of the 24 patients in this group,the lesion sites of 5 patients were in the superior sagittal sinus and 19 were in the lateral sinus.Hyperform 7×7 mm balloon was used in superior sagittal sinus lesion and lateral sinus lesion in 1 patient each.Peripheral vascular dilatation balloons were used in all of the remaining patients.② 3 patients with superior sagittal sinus lesion were embolized via arterial approach,and 2 via venous approach.The venous sinuses were almost embolized with balloons.Ten patients with lateral sinus lesion were embolized via arterial approach,7 via venous approach,and 2 via both arterial and venous approaches.The venous sinuses were almost embolized in 8 patients and were partially embolized in 11 patients with balloons.③ 3 patients with superior sagittal sinus lesion were cured,2 of them showed no recurrence after following up for 6 months,and 1 had a few residuals after embolization.Angiography showed no significant change after 1 year.Among patients with lateral sinus lesion,the fistula disappeared in 1 patient after 2 sessions of embolization,and the remaining patients were cured by one session.Seven of them were followed up with angiography after 6 months,and no recurrence was observed.Conclusion The balloon-assisted embolization of lateral sinus(transverse sinus and sigmoid sinus) and superior sagittal sinus in the treatment of DAVF with Onyx18 are a relatively safe and effective method.It may maximumly maintain the venous sinus patency.