经动脉入路Onyx-18栓塞治疗小脑幕硬脑膜动静脉瘘

目的探讨一组经动脉入路应用Onyx-18栓塞小脑幕硬脑膜动静脉瘘的临床治疗经验。方法于2005年9月～2007年2月期间,连续经动脉入路应用Onyx-18治疗8例小脑幕硬脑膜动静脉瘘患者,就临床表现、影像学、治疗策略及结果进行研究。结果8例均有软膜静脉逆流,Cog-nard分型均为Ⅳ型,其中6例患脑出血,2例有进行性神经功能障碍。术后6例血管造影示病变消失,1例术后神经功能下降。随访2～12个月,术后神经功能下降患者神经功能有所改善,均未出现再次颅内出血,6例GOS=5,2例GOS=4。结论经动脉入路应用非黏附性液体栓塞剂栓塞可以完全栓塞小脑幕硬脑膜动静脉瘘。

Transarterial Onyx-18 embolization of tentorial dural arteriovenous fistulas

Objective To explore the clinical therapeutic experience of a series of tentorial dural arteriovenous fistulas(DAVFs) treated by transarterial embolization with Onyx-18.Methods Eight patients with tentorial DAVFs were sequentially treated between September 2005 and February 2007.All patients were treated transarterially with Onyx-18 in succession.The clinical presentation,radiological,treatment strategies and results were studied.Results Retrograde leptomeningeal venous drainage was documented in every patient,classifying those lesions as Cognard Type IV.Of the eight patients,six cases presented with intracranial hemorrhage and two with progressive neurological deficits.Postoperative angiography demonstrated the obliteration in 6 cases.One patients experienced neurological decline after endovascular treatment,and exhibited clinical improvement and had no intracranial rehemorrhage during the period of follow-up.Clinical follow-up lasted for 2 to 12 months.GOS=5 were in Six patients,GOS=4 in two cases.Conclusions Transarterial embolization of tentorial DAVF is feasible and may result in complete occlusion of the fistulous connection with liquid and non-adhesive embolism.