经动脉途径低浓度氰基丙烯酸正丁酯栓塞治疗海绵窦硬脑膜动静脉瘘

目的 探讨经动脉途径低浓度(14%～25%)氰基丙烯酸正丁酯(NBCA)栓塞治疗海绵窦硬脑膜动静脉瘘(DCCFs)的可行性.方法 8例DCCFs患者均经动脉入路,使用微导管嵌顿技术注入低浓度NBCA行栓塞治疗.其中5例为经静脉入路栓塞失败者,3例为不可行静脉入路栓塞治疗者.结果 5例患者术后即刻血管造影DCCFs完全消失;随访6～12个月,临床症状完全消失,血管造影未发现DCCFs复发.3例患者术后即刻血管造影DCCFs残留,但血液分流量减少;随访3个月,血管造影血液分流明显减少、临床症状改善2例,血液分流和临床症状均消失1例.1例患者术后出现一过性眼部症状恶化、第Ⅵ脑神经麻痹,经治疗后3 d症状消失.结论 经动脉采用微导管嵌顿技术低浓度NBCA栓塞DCCFs是一种安全有效的方法,对于经静脉入路栓塞失败或不能经静脉入路治疗的患者,可能是一种较为理想的选择.

Transarterial embolization of dural carotid cavernous fistulas with low concentration of n-butyl-cyanoacrylate

Objective To investigate the technique of transarterial embolization of dural carotidcavernous fistulas(DCCFs)with low concentration(14%-25%)of n-butyl-cyanoacrylate(NBCA)and determine its value.Methods Eight patients with DCCFs were treated by transarterial embolization with low concentration of NBCA using a wedged microcatheter.Of the 8 patients,5 had unsuccessful transvenous embolization and 3 could not be treated with transvenous embolization.Results Transarterial embolization with low concentration of NBCA using a wedged microcatheter resulted in complete obliteration of the affected cavernous sinus and related shunts in 5 patients,no residual arteriovenous shunt was demonstrated on postembolization angiography.On clinical and angiographic follow-up 6-12 months later,complete resolution of clinical symptoms was observed in all 5 patients and there were no recurrent or residual DCCFs found.Partial obliteration of the involved cavernous sinus and the related shunt was achieved in the remaining 3 patients on immediate post-procedure angiography,but the volume of shunt diminished significantly.On clinical and angiographic follow-up 3 months later,in 2 patients,clinical symptoms were improved and the arteriovenous shunts were diminished;in the third patient,clinical symptom resolved and the shunt was obliterated.There were no major complications except for the transient worsening of ocular symptoms due to Ⅵ cranial nerve palsy in 1 patient.Conclusions Transarterial embolization of DCCFs with low concentration of NBCA using a wedged microcatheter was a safe and effective treatment method.It is an optimal alternative for the patients with DCCFs in which transvenous route was unsuccessful,or impossible.