经动脉入路Onyx栓塞海绵窦区硬脑膜动静脉瘘  

Transarterial embolization of carvernous sinus dural arteriovenous fistulas with Onyx

作　　者：李强[1] 许奕[1] 张琪[1] 洪波[1] 黄清海[1] 方亦斌[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12期620-625,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(30872677);上海市卫生局青年科研课题

摘　　要：目的经动脉入路以Onyx栓塞海绵窦区硬脑膜动静脉瘘(CSDAVF)的疗效观察。方法回顾性分析2006年5月—2010年5月在第二军医大学长海医院神经外科经动脉入路栓塞治疗的CSDAVF患者10例,其中女8例,男2例,Borden分型Ⅰ型2例,Ⅱ型8例。均在全身麻醉下以Onyx-18栓塞治疗。结果①10例患者共进行11次介入治疗,8次术中即刻被完全栓塞,3次被部分栓塞,其中1例第2次治疗时被完全栓塞,2例被部分栓塞的患者随访造影显示完全栓塞。共经14支供血动脉栓塞,其中咽升动脉5次,脑膜中动脉3次,脑膜副动脉5次,眼动脉脑膜返动脉1次。平均注胶时间为32.9min(10～63 min),注胶量为1.8 ml(0.8～3.1 ml)。②平均随访27个月(4～51个月)。患者症状均有好转。被完全栓塞的患者术后即刻颅内杂音消失,球结膜充血、眼球突出在术后1周内消失,复视和视力下降症状在术后1～3个月内好转;被部分栓塞的3例患者术后即刻杂音减轻,3个月后完全消失,眼部症状在3个月后完全消失。③1例BordenⅡ型患者在被部分栓塞后3.5年发生颅内出血,第2次术后随访7个月,未见再出血和眼部症状;2例术中Onyx弥散至颈内动脉系统,1例出现永久性脑神经麻痹。结论采用Onyx经动脉入路栓塞可以有效地治疗CSDAVF,但应注意避免危险吻合栓塞带来的并发症。Objective To observe the efficacy of transarterial embolization of cavernous sinus dural arteriovenous fistulas （CSDAVFs） with Onyx. Methods Ten patients with CSDAVFs （8 females and 2 males） embolized transarterially from May 2006 to May 2010 in Changhai Hospital, the Second Military＇ Medical University were analyzed retrospectively. Two were Borden type I and 8 were Borden type II according to the drainage patterns. They were all embolized with Onyx under general anesthesia. Results （1）Eleven inter- ventional therapeutic procedures were performed in the 10 patients, 8 procedures achieved immediate eomplete embolization, and 3 were partially embolized, and one of them aehie^ed complete embolization alter the second procedure. Follow-up angiography showed complete occlusion in the 2 patients of partial embolization. A total of 14 feeding arteries were embolized, including 5 ascending pharyngeal arteries, 3 middle meningeal arteries, 5 accessory meningeal arteries, and 1 refluent meningeal artery, arising from the ophthalmic artery. The mean time of injecting Onyx was 32.9 rain （ 10 - 63 min）, and the volmne of injecting Onyx was 1.8 mL （0.8 -3.1 mL）. （2）The men fullow-up period was 27 （4 to 51 ） months. The symptoms of patents were all improved. The intraeranial bruit disappeared immediately after the procedure in patients of complete embolization. Conjunctival hyperemia and exophthahnos disappeared within 1 week after theprocedure, and the symptoms of diplopia and decreased visual acuity improved within 1 to 3 months after the procedure. The intracranial bruit and the eye symptoms in the 3 patients of partial embolization was alleviated immediately after the procedure, and completely disappeared after 3 months. （3）One patient of Borden II type occun＇ed intracranial hemorrhage 3.5 years after partial embolization, no rebleeding and eye symptom were found after the second procedure during follow-up for 7 months. Onyx dispersed into internal carotid artery, system in 2 patients du

关 键 词：动静脉瘘 硬膜 海绵窦 导管插入术 外周 拴塞 治疗性 Onyx共聚物 

分 类 号：R743.3[医药卫生—神经病学与精神病学]