经岩下窦途径栓塞海绵窦区硬脑膜动静脉瘘

目的：探讨经岩下窦栓塞治疗海绵窦区硬脑膜动静脉瘘（CSDAVF）的可行性、安全性及有效性。方法回顾性分析17例经岩下窦栓塞治疗的CSDAVF患者的临床资料，其中岩下窦显影14例，未显影岩下窦3例。经颈内静脉的起始段探查显影或未显影岩下窦，进入海绵窦后栓塞CSDAVF。首先微导管送至前端眼静脉开口内，用弹簧圈栓塞眼静脉开口，再通过微导管注射液体栓塞剂Onyx-l8栓塞海绵窦，观察置管的成功率、安全性和栓塞的疗效。术后6月门诊或DSA随访。结果17例中，2例出现短暂的动眼神经麻痹，2月后完全缓解，其他未出现并发症，无死亡病例。1例未经患侧岩下窦引流患者，经对侧岩下窦进入患侧海绵窦内，但未能进入引流动静脉瘘的海绵窦分隔内而失败。其余16例患者均顺利置管，并成功栓塞。所有患者栓塞后即刻造影均未见异常静脉窦早显，瘘口消失，达到了影像学上治愈。置管成功率及治愈率均为94％（16/17）。术后6月对6例患者进行DSA 随访，无1例复发；对其余患者进行门诊随访，临床症状均好转或消失。结论经岩下窦途径栓塞CSDAVF是一种可行的、安全的、有效的方法，可作为CSDAVF的首选治疗方法。

Embolization of Cavenous Sinus Dural Arteriovenous Fistulas Via Inferior Petrosal Sinus

Objective To explore the feasibility ,safety and effectiveness with endovascular treat-ment of CSDAVF via inferior petrosal sinus . Methods Retrospective analysis showed 17 cases with CS-DAVF which treated by embolization via inferior petrosal sinus . Inferior petrosal sinus opacified in 14 ca-ses ,unopacified in 3 cases . CSDAVFs were embolized by probing unpacified and pacified inferior petrosal sinuses via the initial segment of internal jugular veins into the cavernous sinuses . First of all ,micro catheter was sent to the superior ophthalmic vein ,and the detachable coils were embolized in the near side of superior ophthalmic vein ,then ONYX18 was injected into cavernous sinus . We observe the success rate of catheterization ,safety ,efficacy of embolization . Patients were followed-up for 6 months by clini-cal consultation or DSA examination . Results Two cases with short time oculomotor nerve paralysis which improved thoroughly 2 months later ,others without any complications ,no deaths . One case with-out inferior petrosal sinus drainage ,though micro catheter was sent to affected side cavernous sinus via op-posite inferior petrosal sinus ,but it was failed to lead into cavernous sinus separation . Micro catheters were successfully sent to cavernous sinuses in the rest of the 16 cases ,and DAVFs were embolized success-fully . No abnormal venous sinus displayed in immediate angiography and fistulas disappeared in 16 cases , and achieved cure on image . Both successful rate of catheterization and cure rate were 94% （16/17） . Six patients were follow-up by DSA in 6 months ,no one recurrence . Others were follow-up by clinical consultation ,their clinical symptom improved or disappeared . Conclusion Endovascular embolization via inferior petrosal sinus approach is a feasible ,safe and effective method for CSDAVF ,it can be used as the first choice for the treatment of CSDAVF .