经动脉途径以低浓度氰基丙烯酸正丁酯栓塞硬脑膜动静脉瘘的疗效分析  

Treatment of dural arteriovenous fistula by transarterial embolization with low dose of N-butyl-2-cyanoacrylate

作　　者：陈左权[1] 邓东风[1] 顾斌贤[1] 韩洪杰[1] 潘庆刚[1] 海舰[1] 王飞[1] 

机构地区：[1]同济大学脑血管疾病治疗中心同济医院分中心,上海200065

出　　处：《中华医学杂志》2006年第3期157-159,共3页National Medical Journal of China

摘　　要：目的 探讨经动脉途径以低浓度氰基丙烯酸正丁酯栓塞治疗硬脑膜动静脉瘘的技术方法和疗效。方法 采用低浓度（10％～20％）氰基丙烯正丁酯（NBCA）经供血动脉对18例不同部位硬膜动静脉瘘患者进行栓塞治疗。18例患者中海绵窦区硬膜动静脉瘘12例，顶部硬膜动静脉瘘6例。该技术的关键操作方法是将低浓度NBCA注入静脉端使之闭塞并反流入其他供血动脉。结果 18例患者中17例在栓塞后达到解剖治愈，术后临床症状消失。另1例通过海绵窦区硬膜动静脉瘘栓塞后一度症状好转，2d后症状加重，复查造影发现静脉未完全闭塞，回流静脉发生改变，经压颈10d后症状明显好转。结论 经动脉途径以低浓度NBCA栓塞治疗硬脑膜动静脉瘘对于有些病例是较好的选择，其特点是低廉、快捷，疗效满意。Objective To evaluate the efficacy of treatment of dural arteriovenous fistula （DAVF） by transarterial embolization with low dose of N-butyl-2-cyanoacrylate （NBCA）. Methods Eighteen patients, 6 males and 12 females, aged 47. 5 （23 -72）, with DAVF, 12 with carotid cavernous fistula and 6 with fistula in parietal lobe, underwent transarterial embolization with low dose of NBCA （ 10% - 20% ）. The key point of transarterial embolization with low dose of NBCA was that low dose NBCA was injected and embolized the veins and then was reversed into the other supplying arteries. Results Seventeen patients with DAVF in cavernous region and 6 patients with DAVF in parietal lobe were cured anatomically, with the clinical syndromes disappearing. In 1 patient with DAVF in cavernous region the clinical syndrome were moderately improved after transarterial embolization, however, worsened 2 days later. Cerebrovascular angiography demonstrated that the vein was not completely embolized and the draining vein was broadened, and the clinical syndromes were moderately improved again after carotid artery compression therapy for 10 days. Conclusion Convenient and fast, and with low cost and satisfying efficacy, transarterial embolization with low dose of NBCA is a better choice for treatment of DAVF in some cases. The key point of this approach is that the tip of microcatheter is close as much as possible to the fistulae, and NBCA is injected into the fistulae and make the vein diffused well. Attention should be paid to avoid dangerous anastomasis.

关 键 词：动静脉瘘 氰化物 栓塞 

分 类 号：R743[医药卫生—神经病学与精神病学]