难治性颈动脉海绵窦瘘治疗的探讨

目的 探讨栓塞治疗复发及难治性颈动脉海绵窦瘘的对策。方法 回顾分析52例颈动脉海绵窦瘘患者中的5例，3例外伤性颈动脉海绵窦瘘和2例自发性颈动脉海绵窦瘘病例。结果 2例球囊栓塞后复发再次调整球囊型号或增加球囊而完全闭塞瘘口，1例球囊栓塞后复发以微弹簧圈填塞小瘘口，1例经动脉途径失败而经静脉途径填塞弹簧圈使瘘口闭塞，1例自发性颈动脉海绵窦瘘病例因瘘口巨大应用4枚球囊仍有较大瘘口残余而经BOT实验后将同侧颈内动脉及瘘口闭合而使之临床治愈。结论 对颈动脉海绵窦瘘球囊栓塞后复发，瘘口过大、过小、动脉途径治疗困难等情况应用不同材料及治疗途径可取得良好的治疗效果。

Investigation of the treatment of Carotid-cavernous fistula

Objective To investigate the strategy of the intravascular embolotherapy for recunent and refractory CCF. Method We retrospectively analyzed 5 cases of CCF among 52 patients, including three TCCFs and two SCCFs. Result Two cases recurred after embulotherapy of balloon. One case was filled with micro-coils. The fistulas of other two were occluded completely through changing types or the number of balloons. When it was difficult via artery, one case was occluded via vein with coils. Because the fistula was huge, it as well as the internal carotid artery was embolized in one case of SCCF. Conclusion For the recurrent cases after embalotherapy of balloon, such as too huge or small fistulas, and treatment difficultly via artery, if combined with different agents and therapy approach, satisfactory result will be obtained.