弹簧圈结合Onyx胶栓塞外伤性颈动脉海绵窦瘘的治疗体会  

Experience of treating traumatic carotid-cavernous fistula with coils and Onyx

作　　者：邱雷[1] 张翔[2] 张全斌[2] 孙继平[2] 陈左权[2] 

机构地区：[1]山东省淄博市中心医院神经外科,255036 [2]上海同济大学附属第十人民医院神经外科

出　　处：《中华神经外科杂志》2014年第2期121-124,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨弹簧圈结合Onyx胶栓塞外伤性颈动脉海绵窦瘘（traumaticcarotidcavernousfistula，T-CCF）的疗效及安全性。方法通过造影明确外伤性颈动脉海绵窦瘘瘘口的位置及回流特点后，经动脉人路将微导管自颈内动脉瘘口处送入病变侧海绵窦内，同时将保护球囊于颈内动脉瘘口处间断充盈以阻断瘘口血流保护颈内动脉，在海绵窦内近瘘口处填入少量弹簧圈后分次推注Onyxl8胶，直至瘘口完全闭塞。结果12例T-CCF患者共计13个瘘口（含1例双侧病变）在球囊辅助下采用弹簧圈结合Onyx胶进行栓塞治疗，其中11例单侧CCF术毕即刻造影显示瘘口完全消失；另1例双侧CCF分两次进行了栓塞。全部病例颈内动脉均保持通畅，术后原有的颅内杂音全部消失，眼部症状有不同程度恢复，术后未出现严重操作相关并发症，1例术后常规CT复查显示发生同侧侧裂区少量出血；随访3～20个月未见复发。结论弹簧圈结合Onyx胶栓塞颈内动脉海绵窦瘘是一种安全有效的治疗方法。Objective To discuss the effectiveness and safety of endovascular treating method of coils combined with Onyx on traumatic carotid-cavernous fistula （T-CCF）. Methods After confirming the location of traumatic carotid-cavernous fistula as well as draining characteristics, a micro-catheter was sent into the cavernous sinus of lesion side by transarterial approach with a balloon inflated to cover the fistula and protect the ICA. After several coils were deployed adjacent to the fistula, Onyx 18 was injected into cavernous sinus until the complete occlusion of fistula. Results Balloon-assisted embolization of coils combined with Onyx was adopted in totally 12 T-CCF cases of 13 CCF fistula （involving 1 case of bilateral lesion）, among which 11 cases of unilateral lesion showed complete occlusion of fistula in immediate angiogram after treatment, and the other case of bilateral lesion underwent two sessions of embolization. All cases preserved the internal carotid artery lumen. The original symptoms of cranial bruit all disappeared and the ocular and orbital symptoms recovered to different levels. No severe complication related to operation occurred, though l case experienced a small amount of bleeding in the lateral fissure zone of the same side from routine CT scan after operation. Follow-up found no recurrence in 3 to 20 months. Conclusions Embolization with coils and Onyx is an effective and safe way on treatment of T-CCF.

关 键 词：外伤性颈动脉海绵窦瘘 弹簧圈 ONYX胶 栓塞 

分 类 号：R651.1[医药卫生—外科学]