经动脉入路栓塞前颅窝底硬脑膜动静脉瘘  

Transarterial embolization of dural arteriovenous fistula of the anterior cranial fossa

作　　者：李强[1] 许奕[1] 张琪[1] 洪波[1] 黄清海[1] 赵文元[1] 刘建民[1] 

机构地区：[1]第二军医大学附属长海医院神经外科,上海200433

出　　处：《中国脑血管病杂志》2010年第7期354-359,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(30872677);上海市科委重点项目(074119506)

摘　　要：目的评价经动脉入路栓塞前颅窝底硬脑膜动静脉瘘(DAVF)的安全性和有效性。方法回顾性分析7例经动脉入路栓塞的前颅窝底DAVF患者的临床资料,其中CognardⅢ型1例,Ⅳ型6例。表现为颅内出血 5例,眼部症状2例。均采用经筛动脉入路,以10%～15%液态栓塞剂NBCA栓塞2例,Onyx-18栓塞5例。对2例合并供血动脉血流相关性动脉瘤者,均首先栓塞动脉瘤。结果 7例中,经单支供血动脉栓塞即获完全栓塞者5例,其中2例用球囊辅助微导管超选技术;部分栓塞2例,分别在1周及1个月后造影,见瘘口再开放,再次进行多支供血动脉栓塞,直至瘘口基本不显影。1例因NBCA胶过度弥散发生对侧眼动脉阻塞,术后出现视力下降。7例均获临床随访(6～107个月),改良Rankin量表评分0～1级5例,2级1例,3级1例。4例获造影随访,均未见瘘口显影。结论经动脉入路栓塞前颅窝底DAVF安全有效。术中应严格控制栓塞剂返流及过度弥散,防止发生视网膜中央动脉栓塞等并发症。Objective To evaluate the safety and efficacy of the transarterial embolization of dural arteriovenous fistula （DAVF） of the anterior cranial fossa. Methods Seven cases of DAVF of anterior cranial fossa were treated with transarterial embolization during the interval from 2001 to 2009 in Changhai hospital, Second Military Medical University. Six patients were grade IV and the other patient grade m according to the Cognard grade. Five patients presented with intracranial hemorrhage and the other 2 patients with ophthalmic disorders. Embolization was performed through thc ethmoidal arteries. 10% or 15% NBCA were used in 2 cases and Onyx-18 were used in the recent 5 cases. Result The DAVF was totally obli- terated in 5 patients through a single feeding artery, 4 of which were embolized with Onyx-18, and 2 catheterations were assisted with balloon. In the other 2 cases, the initial injection of NBCA and Onyx did not result in adequate permeation of the fistula and multiple catheterations eventually resulted in nearly total oh- literation one week and one month after the first embolization respectively. Two flow-related aneurysms of the feeding artery were coiled before the procedure, one of which was the source of bemoIThage. One pa- tient complicated with decreased visual acuity as a consequence of excessive permeation of NBCA into the contralateral ophthalmic artery. All patients were followed up （6 - 107 months）, the modified Rankin Scale score 0 to 1 in 5 cases, 2 in 1 case and 3 in 1 case. Angiographic follow up was obtained in 4 cases, and no fistula was observed. Conclusion It is safe and effective to embolize the DAVFs of the anterior cra- nial fossa through transarterial approach. In order to prevent complications, reflux must be controlled while injecting the liquid embolic agent, and excessive permeation must also be avoided concerning the dangerous anastomosis.

关 键 词：动静脉瘘 硬膜 颅窝 前 栓塞 治疗性 筛动脉 

分 类 号：R743.3[医药卫生—神经病学与精神病学]