ONYX 18栓塞天幕区硬脑膜动静脉瘘的临床研究(附四例报道)

目的 探讨经动脉途径使用ONYX 18栓塞治疗天幕区硬脑膜动静脉瘘的临床方法 及疗效. 方法 回顾性分析宣武医院神经外科自2008年3月至7月收治的4例天幕区硬脑膜动静脉瘘患者的临床资料(包括病史、查体、影像学检查、手术记录、随访情况等),其中急性蛛网膜下腔出血1例,进行性神经功能障碍3例;瘘口位于天幕顶2例,天幕左侧1例,天幕后份1例;硬脑膜动静脉瘘分型为Ⅱb型2例,Ⅲ型1例.Ⅳ型1例.4例患者均行经动脉途径使用ONYX 18栓塞治疗(ONYx注入量分别为1.5 mL、3.5 mL、9 mL、12 mL),1例合并阻塞性脑积水者在栓塞后行脑室腹腔分流术. 结果 本组患者术后完全栓塞3例,1例残余枕动脉少许供血瘘口,血流明显减慢.4例患者门诊或电话随访3个月,原有症状均无出现. 结论 在微导管到达合适的位置时,通过正确的注射ONYX 18,通过单一供血动脉,可以将整个天幕区硬脑膜动静脉瘘的瘘口、静脉端及所有供血动脉填塞.达到完全治愈.该方法 治疗高危硬脑膜动静脉瘘安全有效.

Embolization of tentorial dural arteriovenous fistula with ONYX-18

Objective To assess the therapeutic effect of arterial embolization with ONYX-18 for treatment of tentorial dural arteriovenous fistula (DAVFs). Methods The clinical data (including the disease history, radiographic examination, surgical record, and follow-up data) of 4 patients with DAVF treated between March and July, 2008 were retrospectively analyzed. Of the 4 patients, one had acute subaraclmoid hemorrhage, and 3 exhibited progressive neurological deficits. The fistula orifice was located on the top of the tentorium in 2 cases, on the left tentorium in one case and in the posterior tentorium in the other. Type Ⅱ b DAVF was found in 2 cases, type Ⅲ in one case and type IV in the other ease. All the 4 patients underwent arterial embolization with ONYX-18, with ONYX-18 dose of 1.5, 3.5, 9, and 12 mL, respectively. One patient underwent ventricuioperitoneal shunt after the embolization because of obstructive hydrocephalus. Results The fistulae were embolized completely in 3 cases, and in one patient, a small quantity of blood supply to the fistula orifice was present fi'om the occipital artery, but the blood flow velocity was obviously reduced. Follow-up of the patients for 3 months revealed no occurrence of the former symptoms after the embolization. Conclusion ONYX-18 injection through one single feeding artery after placement of the micro-catheter at the appropriate position allows effective embolization of the fistula orifice, the supplying arteries and the venous ends to achieve safe and effective embolization of DAVF.