外伤性颈内动脉海绵窦瘘栓塞术后复发原因及治疗  

Exploration of the cause and treatment of recurrent traumatic carotid cavernous fistula after endovascular embolization

作　　者：徐军[1] 乔秀媛 陈建勇[2] 王君[3] 李宝民[3] 

机构地区：[1]山东省青岛市第八人民医院神经外科,266100 [2]山东省胶南市人民医院神经外科 [3]解放军总医院神经外科

出　　处：《中国现代神经疾病杂志》2009年第1期50-54,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的对外伤性颈内动脉海绵窦瘘栓塞术后复发患者的临床资料进行回顾性分析，探讨复发原因及治疗方案。方法16例外伤性颈内动脉海绵窦瘘栓塞术后复发患者的首次复发时间为首次球囊栓塞术后3d-3个月，分别采用再次血管内球囊栓塞术、单纯压颈、球囊联合水解脱微弹簧圈栓塞以及开颅手术联合血管内球囊栓塞术等方法进行治疗。结果16例患者中10例经再次血管内球囊栓塞术治愈，1例单个瘘口患者经压颈治疗痊愈，3例再次复发患者通过球囊联合水解脱微弹簧圈栓塞成功，1例经静脉途径应用水解脱微弹簧圈完全闭塞瘘口，余1例施行开颅手术夹闭孤立性瘘口并辅助血管内球囊栓塞术治愈。其中6例患者完全闭塞患侧颈内动脉，手术后无一例发生并发症。随访4个月～2年均未再复发。结论外伤性颈内动脉海绵窦瘘栓塞术后复发可能与球囊质量、充盈状态、位置、瘘口直径、颅底骨折和异物以及颈内、外动脉系统和大脑前、后循环吻合支开放有关。再次治疗时，应认真分析复发原因，制定相应的治疗方案，以达到满意的临床疗效。Objective To investigate the factors and strategy for recurrent traumatic carotid cavernous fistula （TCCF）. Methods Retrospectively analysed the cause and treatment of 16 cases with recurrent TCCF. Sixteen patients were treated by endovascular detachable balloon （DB） embolization simple internal carotid arterial compression, DB embolization combined with hydro-detachable coils, or endovascular DB embolization in combination with operation. All balloons were supplied by France Bait company. Results Sixteen cases with recurrent TCCF occurred from 72 h to 3 months after treatment. Among them, 10 cases were healed by endovascular DB embolization for the second time, one single-fistula case was cured by internal carotid arterial compression, 3 cases recurred for twice were successfully treated by endovascular DB embolization combined with hydro-detachable coils. Further more, in one case the fistula was completely occluded with hydro-detachable coil by transvenous approach and in another case the fistula was isolated by craniotomy and then occluded by endovascular DB embolization. No complications were seen in 6 cases after complete internal carotid artery occlusion. All cases were followed up from 4 to 24 months and no recurrence occurred. Conclusion The recurrent factors of TCCF after endovascular embolization may be related to the balloon quality, balloon inflated condition, the displayed position, size of the fistula, basal skull fracture and foreign bodies, and the opening of anastomotic branches between internal and external carotid arterial system and anterior and posterior cerebral circulation. The recurrence factors should be seriously investigated and lay out a therapeutic programme before secondary treatment to achieve clinical therapeutic efficiency.

关 键 词：颈动脉海绵窦瘘 复发 栓塞 治疗性 

分 类 号：R651.1[医药卫生—外科学]