面静脉-眼上静脉入路填塞海绵窦

目的评价经面静脉-眼上静脉入路填塞海绵窦治疗颈动脉海绵窦瘘（CCF）的有效性。方法经股静脉-面静脉-眼上静脉入路到达患侧海绵窦，用GDC或EDC，游离弹簧圈，真丝线段等多种栓塞材料填塞海绵窦，同时闭塞瘘口。面静脉插管困难者，在下颌角附近切开皮肤显露面静脉，直视下穿刺面静脉放置相应导管，再经眼上静脉到达患侧海绵窦并将其填塞。结果经面静脉-跟上静脉入路对14例，16侧海绵窦进行了栓塞治疗，其中5例为外伤性、直接CCF（A型），经动脉途径球囊栓塞后复发，或微弹簧圈栓塞未能成功，或经岩下窦入路未能成功，9例为自发性、间接CCF（D型8例，C型1例）。13例经股静脉-面静脉-眼上静脉途径，1例通过直视下面静脉穿刺。11例栓塞治疗后即刻造影显示瘘消失，2例残留低流量的岩下窦引流，另有1例在微导管进入面静脉后，而静脉痉挛闭塞，未能继续进行栓塞治疗，造影仍见瘘存在，但眼静脉出现明显的造影剂滞留。1例A型CCF在球囊栓塞后出现外展神经麻痹，经面静脉-眼上静脉栓塞后亦无改善。因面静脉痉挛闭塞未能栓塞成功者，于术后即感眼部症状加重，但第2天感症状缓解，术后第21天症状明显改善，造影检查发现瘘门已经消失，术后1个月病人眼部症状完全消失。其他病例在栓塞术后眼部症状明显改善，最后消失。随访3个月至21个月未见复发。2例残留瘘口者，1例于3个月和12个月进行2次造影复查，另1例于3个月造影复查，瘘的流量均无明显变化，因无临床症状未再进行治疗。其他病例未进行造影复查。结论经面静脉-眼上静脉栓塞治疗CCF安全有效，对于A型CCF，可作为经动脉途径治疗失败后的补救措施，而对于B、C、D型CCF，应作为首选治疗。

Packing of cavernous sinus with facial vein-superior ophthalmic vein approaches

Objective To evaluate the efficacy of facial vein-superior ophthalmic vein approach to embolize carotid-cavernous sinus fistulas. Methods The involved cavernous sinus was catheterized through the femoral vein-facial vein- superior ophthalmic vein approach. GDC, EDC, free microcoil, or silk were used to pack the sinus and occlude the shunt. If there was any difficulty in catheterizing the faical vein, facial vein was exposed surgically and punctured, and then, through the superior opthalmic vein, the cavernous sinus was packed. Results 16 cavernous sinuses in 14 CCF patients(5 traumatic CCFs, 9 dural CCFs) were catheterized through facial vein-superior ophthalmic vein approach, and the technical success was achieved in 15 cavernous sinuses. Immediate angiographic cure of the shunts was achieved in 11 cases, residual shunts with inferior petrosal sinus drainage in 2. Facial vein occlusion was encountered in 1 patient during the facial vein catheterization, further packing of the cavernous sinus was not performed, but follow-up angiography at the 21st day revealed spontaneous cure of the shunt. The VI cranial nerve palsy present after balloon embolization in a type A CCF was not improved after packing of the cavernous sinus. Ocular symptoms in other patients disappeared after tranvenous embolization. The clinical follow-up period ranged from 3 to 21 months, no recurrence of the symptoms was found. Follow-up angiography in 2 patients with residual shunting showed unchanged shunts, no further embolization was performed. No follow-up angiography was performed in other patients. Conclusions The facial vein-superior ophthalmic vein approach can be chosen as an optimal treatment for dural CCFs, and an important alternative treatment for type A CCFs after the failure of the initial balloon embolization.