经岩下窦静脉入路治疗颈动脉海绵窦瘘

目的探讨经岩下窦静脉入路治疗颈动脉海绵窦瘘(CCF)的疗效。方法经股静脉-岩下窦入路到达病变侧海绵窦，用各种弹簧圈如GDC、EDC、Matrix、FreeCoil和丝线等多种材料填塞海绵窦，同时闭塞瘘口。结果经股静脉-岩下窦入路对18例、21侧海绵窦进行了栓塞治疗。16例治疗后造影显示海绵窦和瘘口完全闭塞，无静脉引流；2例虽将海绵窦瘘口密实填塞，但仍有低流量翼丛引流，术后临床症状减轻，压颈1周后症状消失。栓塞术后病人主要表现为头痛和呕吐。2例术前伴有动眼神经麻痹病人，栓塞治疗后其他症状消失，但动眼神经功能未恢复。1例栓塞术后出现一过性外展神经麻痹，后自行恢复。有7例为外伤性，经动脉途径球囊栓塞后复发，或经弹簧圈治疗未成功。有11例为自发性，除3例岩下窦引流不明显，经硬导丝努力打通该通路，余者岩下窦均引流明显，导丝较易通过。随访3个月至24个月，6例病人术后3个月回医院行全脑血管造影检查，未发现复发；余者因术后无症状未回医院复查。结论经岩下窦静脉入路治疗CCF安全有效，对于外伤性CCF，为经动脉入路失败后治疗该病的主要治疗方法，而对于自发性CCF，应作为首选治疗。

Transvenous embolization of carotid - cavernous sinus fistula via the inferior petrosal sinus pathway

Objective To discuss the effect on transvenous embolization of carotid-cavernous sinus fistula(CCF) via the inferior petrosal sinus(IPS) pathway. Methods The involved cavernous sinuses were catheterized via inferior petrosal sinus approach, and embolized with coils( GDC, EDC,Matrix ,free coil) or coils plus silk. Results 21 cavernous sinuses in 18 patients with CCF were embolized. Immediate complete angiographic obliteration of the fistulas was achieved in 16 patients. Residual shunting was left in 2 patients with pterygoid drainage,but clinical symptoms relieved and these symptoms disappeared by expressing carotid artery. Headache and vomitting were the most common symptoms after embolization. Left oculomotor nerve palsy, present before treatment, remained unchanged in 2 patient, although immediate angiographic cure was achieved. Transient sixth nerve palsy was encountered in 1 patient. 7 patients were traumatic CCF , reoccurred after transarterial embolization .11 patients were spontaneous CCF, except 3 cases drained uneasily via IPS,other were easy and smooth. reoccurred clinical cure was achieved in all the other patients. Angiography at the third month follow-up was performed in 3 patients with residual shunting, angiographic cure in 2, residual pteriod drainage in 1. The follow-up period ranged from 3 months to 24 months. Follow-up angiography was performed in 6 patients after 3 months of postoperation,not reoccur. Other patients did not come to hospital to re-examinate .Conclusions Transvenous embolization of CCF via IPS was a safe and efficient way, and should be considered as an optimun treatment for spontaneous CCF, an important alternative for the traumatic CCF after failure of transarterial embolization.