经未显影静脉窦栓塞治疗硬脑膜动静脉瘘

目的探讨经未显影静脉窦栓塞治疗硬脑膜动静脉瘘（DAVF）的可行性、安全性及有效性。方法回顾性分析92例经未显影静脉窦栓塞治疗的DAVF患者的临床资料，其中病变位于海绵窦区91例，侧窦区1例。经颈内静脉的起始段探查未显影岩下窦，进入引流静脉窦内栓塞海绵窦区DAVF；通过颈内静脉探查未显影乙状窦，进入静脉窦栓塞侧窦区DAVF。首选可控纤毛弹簧圈进行栓塞，待血流减慢以后，用游离纤毛弹簧圈继续栓塞。若仍存在少量瘘口，通过静脉窦内注射液体栓塞剂（25％～33％Glubran或Onyx18），观察置管的成功率、安全性和栓塞的疗效。术后6个月通过电话、门诊或DSA随访。结果92例患者中，均未出现并发症，无死亡病例。1例海绵窦区DAVF患者置管失败；其余91例患者均顺利置管，并成功进行静脉栓塞。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99％（91／92）。术后6个月对38例进行随访，无一例DAVF复发。对其余患者进行电话或门诊随访。所有患者临床症状好转或消失。结论经未显影静脉窦栓塞治疗DAVF，尤其对于海绵窦区DAVF，经未显影岩下窦超选择置管进行栓塞，具有较高的可行性、安全性及有效性，可作为海绵窦区DAVF的首选常规治疗方法。

Embolization of dural arteriovenous fistula via unopacified venous sinus

Objective To explore the feasibility,safety and efficacy of embolization of dural arteriovenous fistulas(DAVF) via unopacified venous sinus.Methods Ninety two patients with DAVF treated by embolization via unopacified venous sinus were selected.The lesions of 91 patients were in the cavernous sinus areas,and the lesion of one patient was in the lateral sinus area.DAVFs in the cavernous sinus areas were embolized by probing the unopacified inferior petrous sinuses via the initial segment of internal jugular veins entering into the draining venous sinuses;DAVFs in lateral sinus areas were embolized by probing the unopacified sigmoid sinuses via internal jugular veins entering into the venous sinuses.The first choice of embolization was the detachable fibered coils.After blood flow slowdown,the free fibered coils were used to embolize continuously.If a few fistulas still existed at the end of embolization,Glubran(25%~33%) or Onyx18 could be injected into venous sinuses.The success rate of catheterization,safety,and efficacy of embolization were observed.The patients were followed up for 6 months by telephone,clinical consultation and DSA examination.Results Among the 92 patients,no complication or death occurred.Catheterization was failed in one patient with DAVF in cavernous sinus area;the catheterization was smooth in the other 91 patients,and their venous embolization was successful.No abnormal venous sinus displayed in immediate angiography after the embolization in all patients,and their fistulas disappeared,which achieved cure on imaging.Both the successful rate of catheterization and the cure rate were 99%(91/92).Thirty-eight patients were followed up by DSA,and the others were followed up by telephone or clinical consultation.The follow-up period was 6 to 12 months.There was no recurrence among the 38 patients who were followed up by DSA for 6 months.The clinical symptoms in all patients were improved or resolved.Conclusion The embolization of DAVF via unopacified venous sinus is a safe and effective method,especially for DAVF in cavernous sinus area.Superselective catheterization for embolization via unopacified inferior petrous sinus has higher feasibility,safety and efficacy.It can be used as a first-choice therapy for the conventional treatment of DAVFs in cavernous sinus areas.