血管内治疗海绵窦区硬脑膜动静脉瘘的疗效分析

目的探讨海绵窦区硬脑膜动静脉瘘（CS-DAVF）的血管内栓塞治疗的技巧及疗效。方法采用血管内栓塞治疗经DSA确诊的CS-DAVF患者34例,其中17例经动脉入路,15例静脉入路,2例经动、静脉联合入路;采用Onyx栓塞17例,弹簧圈栓塞6例,Onyx联合弹簧圈栓塞7例,1例采用Gluebran栓塞。结果 17例经动脉入路栓塞患者中,Class分级1级栓塞10例,2级栓塞6例,3级栓塞1例;15例经静脉脉入路栓塞患者中,1级栓塞10例,2级栓塞2例,3例栓塞失败;2例经动静脉联合入路栓塞患者中,1级栓塞1例,2级栓塞1例。31例成功栓塞的患者术后2例出现动眼神经麻痹,2例Onyx误栓同侧大脑中动脉。18例经DSA随访3~36个月,14例1级栓塞的患者未见复发;4例2级栓塞者2例瘘口完全闭塞,2例仍见瘘口。结论血管内栓塞是治疗CS-DAVF首选方法,依据供血动脉、瘘口特点及引流静脉选择不同途径进行个体化治疗,可以取得满意疗效。

Effect of endovascular treatment on cavernous sinus dural arteriovenous fistulas

Objective To investigate the curative effects of endovascular embolization on cavernous sinus dural arteriovenous fistulas （CS-DAVFs）. Method Of 34 patients with CS-DAVFs diagnosed by DSA, 17 were treated by the transarterial embolization, 15 by the transvenous embolization and 2 by the transarteriovenous embolization. CS-DAVFs were endovascularly embolization by Onyx glue in 17, by the coils in 7, by the both Onyx glue and coils in 8 and by Gluebran in 2. Results Of 17 patients with CS-DAVFs treated by the transarterial embolization, 10 received class Ⅰembolization, 6 class Ⅱ and 1 class Ⅲ. Of 15 patients with CS-DAVFs treated by the transvenous embolization, 10 received class Ⅰ embolization, 2 class II and 3 class III. Of 2 patients with CS-DAVFs treated by the transarterovenous embolization, 1 received class Ⅰ embolization and 1 classⅡ . The oculomotor nerve palsy occurred in 2 patients after the embolization and the ipsilateral middle cerebral arteries were wrong embolized in 2 patients. Of 18 patients followed up by DSA from 3 to 36 months after the embolization, 16 were cured and 2 had the fistulae residue. Conclusions CS-DAVFs should be treated first by the endovascular embohzation. The curative effects of the individualized embolization through the different approaches chosen according to feeding arteries, draininz veins and the characteristics of the fistulae on CS-DAVFs are satisfactory.