颈动脉海绵窦瘘28例诊疗分析  

Diagnosis and treatment of carotid-cavernous fistula ： analysis of 28 patients

作　　者：庞鹏飞[1] 姜在波[1] 周斌[1] 李征然[1] 黄明声[1] 朱康顺[1] 关守海[1] 陈俊伟[1] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,510630广州

出　　处：《中华医学杂志》2012年第21期1458-1462,共5页National Medical Journal of China

摘　　要：目的 颈内动脉入路及岩下窦入路治疗不同类型颈动脉海绵窦瘘（CCF）的临床疗效分析。方法 2005年4月至2010年6月中山大学附属第三医院放射科诊治的28例CCF患者，男13例、女15例，年龄21～71岁，平均39岁。根据Barrow分型，A型21例，B型2例，D型5例。A型患者接受颈内动脉入路可脱球囊栓塞或覆膜支架治疗。B型和D型患者接受岩下窦入路弹簧圈联合氰基丙烯酸正丁酯（n-BCA）栓塞治疗。回顾性分析手术成功率，并发症及临床症状缓解情况。结果 21例A型患者中，16例接受可脱球囊栓塞（球囊1～4个），术后即时造影证实瘘口完全闭塞消失15例，残留小瘘口1例（〈20％）。5例接受覆膜支架（直径4～5mm，长度12～19mm）治疗。置入2枚支架1例，1枚支架4例。瘘口完全闭塞3例。1例残留较大瘘口（〉50％），经支架与血管壁的间隙于海绵窦置入3个可脱球囊后瘘口完全闭塞。支架置入后颈内动脉及瘘口完全闭塞1例。由于对侧血流代偿良好，患者未发生脑梗死。7例B型和D型患者中，完全闭塞患侧海绵窦6例，残留瘘口1例（〈50％）。使用弹簧圈3～8个（平均6个），超液化碘油与n-BCA混合液的体积1．0～2．1ml（平均1．3m1），注射时间45～90s（平均65s）。临床症状完全缓解26例，随访12～60个月，平均30个月。随访期间无复发病例，颈动脉覆膜支架内未发生狭窄、闭塞。结论 直接型CCF首选可脱球囊栓塞。岩下窦入路弹簧圈联合n-BCA栓塞是间接型CCF安全、有效的治疗方案。Objective To evaluate the feasibility and efficacy of endovascular treatment for different types of carotid cavernous fistula （CCF） via the approach of internal carotid artery （ICA） or inferior petrosal sinus （IPS）. Methods From April 2005 to June 2010, 28 CCF patients underwent endovascular treatment at our institution. There were 13 males and 15 females with a mean age of 39 years （range： 21 -71 ）. According to the Ban＇ow＇s classification, they were classified into type A （n = 21 ）, type B （n = 2 ） and type D （ n = 5 ）. Patients of type A underwent detachable balloon embolization of ipsilateral cavernous sinus or stent-graft placement via the ICA approach. Patients of types B and D received detachable coil plus n-BCA （n-butyl-2-cyanoacrylate） embolization of ipsilateral cavernous sinus via the IPS approach. The technical results, complications and therapeutic outcomes were reviewed. Results Detachable balloons （number： 1 -4） were used in 16 patients of type A. Angiography at immediate postembolization showed a complete occlusion of fistula in 15 patients and a small residual fistula （ 〈20% ） in 1 patient. Five patients of type A received stent-graft placement. One stent was placed in 4 patients and 2 stents in 1 patient. Complete fistula closures with preserved ICA were documented on immediate angiogram in 3 patients whereas a large residual flow （ 〉 50% ） persisted in 1. The fistula was completely occluded after 3 detachable balloons were deployed in affected cavernous sinus through a gap between stent and vascular wall. Both fistula and ICA were occluded in 1 patient after stenting. No cerebral infarction was observed due to the adequate collateral blood flow from contralateral ICA. Complete closures of affected cavernous sinus were achieved in 6 patients of types B and D while residual flow （ 〈 50% ） persisted in 1. The number of detachable coils for each embolization ranged from 3 to 8 （ mean ： 6. 0 ）. The volume of n-BCA mixture varied fro

关 键 词：颈动脉海绵窦瘘 支架 放射学 介入性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]