应用水膨胀式微弹簧圈栓塞治疗外伤性颈动脉海绵窦瘘

目的总结水膨胀式微弹簧圈（HydroCoil）栓塞治疗颈动脉海绵窦瘘（CCF）的初步体会，对HydroCoil治疗CCF的有效性作出评价。方法选取我院2006年1月以来应用HydroCoil栓塞系统治疗14例外伤性颈动脉海绵窦瘘（CCF）病人，男9例，女5例，平均26．5岁。脑血管造影显示6例瘘口位于右侧颈内动脉海绵窦段，8例位于左侧颈内动脉海绵窦段。结果14例病人CCF术后均不再显影，患侧颈内动脉通畅，所有病人术前的颅内杂音、突眼和球结膜充血等症状在1周内恢复正常，视力也有不同程度的恢复。8例病人术后获得1—3个月脑血管造影随访，CCF均未见复发。没有神经系统并发症发生。结论血管内介入治疗已经广泛应用于颈动脉海绵窦瘘，可脱球囊栓塞仍为首选方法。当病人不能耐受或不允许闭塞患侧颈内动脉时，可以选用HydroCoil。HydroCoil治疗CCF安全、有效、稳定，颈动脉保持通畅率高，长期临床效果仍有待于进一步研究。

Hydrocoil Embolic System(HES) for traumatic carotid cavernous fistula

Objective To summarize the preliminary experience and effectiveness of treating traumatic carotid cavernous fistula with expandable hydrogel-coated platinum coils ( hydrocoil embolic system, HES). Methods All patients (9 males, 5 females; mean age, 26.5 years) , with a history of severe craniocerebral injury, presented with ocular symptoms including exophthalmos, conjunctival injection, chemosis, and ocular motor palsies. Digital substractional angiography( DSA) revealed 14 carotid cavernous fistulas, 6 fistulas locating at the right segment of cavernous part of the carotid artery, 8 fistulas locating at the left segment of carotid cavernous sinus. All fistulas were embolized using hydrocoil and DCS at our institution. Results After the treatment, angiographic control revealed 14 fistulas complete obliteration. Clinical examination showed total resolution of signs and symptoms of carotid-cavernous fistula within a week, such as progressive chemosis, diplopia and exophthalmus. The parent arteries were kept patency. In the follow-up 1 to 3 months by DSA, carotid cavernous fistula were no recurrence in the 8 cases. No thromboembolic or hemorrhagic complications occurred. No neurologic deterioration was observed during follow-up periods of 1-3 months. Conclusions Placement of detachable balloons is the treatment of first choice to achieve immediate shunt occlusion, although the parent artery occasionally must be occluded. Hydrocoil is valuable if balloon placement fails to permanently obliterate the CCF and sometimes when parent artery occlusion would be required but cannot be tolerated. Treatment for CCF with HES proves to be safe, effective, durable and has an excellent flow through affected side internal carotid artery. Clinical outcome needs further practise and long term follow-up study.