Onyx结合微弹簧圈经静脉入路治疗硬脑膜动-静脉瘘

研究背景采取单纯微弹簧圈栓塞供血动脉姑息治疗硬脑膜动静脉瘘的方法,在栓塞血管巢近端供血动脉后,可出现新的供血动脉并可能改变静脉引流途径,从而增加颅内出血风险。闭塞引流静脉是一种十分有效的治疗方法,且经静脉途径闭塞引流静脉成功率较高,本研究尝试经静脉入路注射液体栓塞剂Onyx结合微弹簧圈栓塞治疗硬脑膜动静脉瘘,并探讨其疗效。方法经静脉入路栓塞治疗12例硬脑膜动静脉瘘患者(海绵窦区8例、横窦乙状窦区4例),通过脑血管造影检查及临床随访评价疗效。结果术后即刻全脑血管造影检查瘘口完全闭塞者11例、瘘口处血流速度明显减慢者1例。随访3个月至3年,临床症状完全消失者11例、明显缓解者1例。结论应用液体栓塞剂Onyx结合微弹簧圈经静脉入路栓塞治疗硬脑膜动静脉瘘安全有效。

Embolization of the dural arteriovenous fistulas by using Onyx and detachable coils via a venous access

Background Simple embolization of supplying artery of dural arteriovenous fistula （DAVF） is usually alleviative treatment. New supplying arteries may appear after embolization of proximal supplying artery of vascular nests and venous draining may be changed, thus the risk of hemorrhage will be increased. The most effeetive method of interventional therapy for DAVFs is embolization of draining veins, and the success rate will be highest via a venous access. This article aims to explore the method and therapeutic results of interventional therapy of DAVF by using Onyx glue and detachable coils via a venous access. Methods A total of 12 patients with DAVFs were treated with transvenous embolization, among whom 8 involved the cavernous sinus and 4 were in transverse- sigmoid sinus. After embolization, angiography and follow- up study were applied to evaluate the clinical efficaeies. Results Immediate postoperative digital subtraction angiography （DSA） indicated that the fistulas were completely occluded in 11 cases and blood flow velocity in fistulas slowed down evidently in I case. The 3-36 months follow-up study found that clinical symptoms disappeared in 11 cases and relieved evidently in 1 case. Conclusion Interventional embolization by using Onyx and detachable coils via a venous access is an effective and safe treatment method for DAVFs.