应用Onyx联合弹簧圈栓塞海绵窦治疗海绵窦区硬脑膜动静脉瘘的经验探讨  

Embolism of cavernous sinus with coils and Onyx in treating cavernous sinus dural arteriovenous fistulas

作　　者：文军[1] 段传志[2] 黄理金[1] 张昕[2] 何旭英[2] 李西锋[2] 

机构地区：[1]南方医科大学附属第三医院神经外科,广州510630 [2]南方医科大学珠江医院神经外科,广东神经外科研究所,广东省脑功能修复与再生重点实验室,广州510282

出　　处：《中华神经医学杂志》2015年第5期501-505,共5页Chinese Journal of Neuromedicine

摘　　要：目的 探讨应用液体栓塞剂Onyx联合弹簧圈栓塞海绵窦治疗海绵窦区硬脑膜动静脉瘘的疗效并总结经验.方法 回顾性分析南方医科大学珠江医院神经外科自2008年8月至2013年2月经岩下窦入路栓塞海绵窦治疗的25例海绵窦区硬脑膜动静脉瘘患者（均经术前眼科检查及常规脑血管造影检查确诊）的临床及影像学资料,其中22例联合应用弹簧圈及Onyx栓塞,3例单用Onyx栓塞.结果 共进行了25次栓塞治疗;弹簧圈平均使用数量为（2.55±0.91）个,平均体积为（32.15±16.03） mm^3;Onyx平均使用量为（2.57±0.86） mL.术后即刻造影显示,单用Onyx的3例（12.0％）患者获得次全栓塞,余22例（88.0％）患者获得完全栓塞;随访造影显示25例（100％）患者均获得完全栓塞.出院时7例（28.0％）患者已无明显症状,18例（72.0％）患者症状有所改善;随访时所有患者症状未见复发.6例（24％）患者发生手术相关的并发症,对应处理后均治愈.结论 有效地应用Onyx联合弹簧圈栓塞海绵窦是成功治愈海绵窦区硬脑膜动静脉瘘并降低并发症的关键.Objective To explore the curative effect of embolism of cavernous sinus with Onyx and coils on cavernous sinus dural arteriovenous fistulas （csDAVFs） and to sum up the experiences.Methods Retrospective analysis of clinical data and radiographic records of 25 patients with csDAVFs who had received embolisation of cavernous sinus using Onyx or in combination with coils through inferior petrosal sinus between August 2008 and February 2013 was performed;all patients were diagnosed by conventional cerebral angiography and received ophthalmological examination before operation.Twenty-two patients used coils and Onyx,three patients used Onyx only.Results Twenty-five embolization sessions were conducted.The mean number of coils was 2.55±0.91 and the mean volume was 32.15±16.03 mm^3 per patient;the mean volume of Onyx was 2.57±0.86 mL per patient.Three patients （12.0%） who used only Onyx achieved subtotal occlusion and other 22 patients （88.0%） were completely occluded in the immediate angiography.All patients （100%） achieved complete occlusion in the follow-up angiography.Seven patients （28.0%） demonstrated no symptoms at discharge time and 18 patients （72.0%） demonstrated symptoms improvement.All patients remained asymptomatic in the subsequent follow-up periods.Six patients （24.0%） occurred complications and all the complications were cured after proper treatment.Conclusion Effective use of Onyx and coils is the key to cure cavernous sinus dural arteriovenous fistulas and reduce the complications.

关 键 词：硬脑膜动静脉瘘 海绵窦 液体栓塞剂Onyx 血管内治疗 并发症 

分 类 号：R743.4[医药卫生—神经病学与精神病学]