外伤性颈内动脉海绵窦瘘的血管内治疗

目的:总结应用多种血管内技术治疗外伤性颈内动脉海绵窦瘘(TCCF)的经验体会。方法:自2003年11月~2007年11月收治TCCF 16例。14例患者单纯应用可脱球囊治疗,1例应用可脱弹簧圈结合NBCA栓塞治疗,1例患者应用可脱球囊治疗失败后应用了覆膜支架治疗。结果:14例应用球囊成功栓塞瘘口,另2例分别应用可脱弹簧圈结合NBCA和覆膜支架最终治疗成功。14例闭塞瘘口并保留了颈内动脉,2例闭塞瘘口的同时闭塞了颈内动脉。无死亡以及手术相关性并发症。随访6~24个月(平均18个月),无1例复发。结论:多种血管内技术可以安全、有效地治疗外伤性颈内动脉海绵窦瘘。首选球囊闭塞瘘口,在球囊闭塞瘘口失败时可考虑应用可脱弹簧圈或覆膜支架。

Endovascular Treatment of Traumatic Carotid-cavernous Fistulas

Objective:We present our experience in treatment of traumatic carotid cavernous fistulas(TCCF) using different therapeutic alternatives such as detachable balloons and detachable coils in combination with N-butyl-2-cyanoacrylate(NBCA) or covered stents.Methods:From the 16 TCCFs treated at our institution between November 2003 and November 2007,a total of 14 TCCFs were treated using detachable balloons alone.One patient was treated with 2 covered stents after a failure with detachable balloon.Another patient had to be treated with coils combining NBCA because he was mistreated by other doctors.Results:14 patients were treated uneventfully using detachable balloons alone.The other 2 patients were treated successfully with coils combining NBCA and covered stents respectively.Control angiograms obtained in the 14 patients demonstrated occlusion of the fistula and preservation of the ICA.There was no mortality and no postprocedural morbidity.No recurrent case was found during a 6 to 24 months' follow-up(mean 18 months).Conclusion:Traumatic carotid cavernous fistulas(TCCF) can be effectively treated by endovascular methods.Detachable balloons should be considered as first choice in these patients.Covered stents or detachable coils could be used in case fistulas cannot be successfully occluded with detachable balloons.