复杂的直接性海绵窦动静脉瘘血管构筑特征及介入治疗  

The vascular architecture characteristics of the complex direct cavernous sinus arteriovenous fistula and its interventional treatment

作　　者：龙霄翱[1] 尹延庆[1] 李捷[1] 段传志[2] 李铁林[2] 

机构地区：[1]湛江广东医学院附属医院神经外科,524001 [2]南方医科大学珠江医院神经医学研究所

出　　处：《介入放射学杂志》2015年第9期750-753,共4页Journal of Interventional Radiology

基　　金：广东医学院附属医院引进博士启动项目(20601B01201)

摘　　要：目的分析复杂的直接性海绵窦动静脉瘘（cd—CAVF）患者血管构筑影像学特征、治疗方式及疗效。方法回顾分析12例复杂cd-CAVF患者住院记录、影像学特征及手术记录。结果12例患者中供血动脉为颈内动脉（ICA）8例，原始三叉动脉1例，脑膜中动脉（MMA）2例，基底动脉（BA）1例；均有不同程度“盗血”现象：经眼上静脉及岩下窦引流10例，皮层静脉引流2例。经ICA栓塞4例，经ICA联合BA栓塞5例，经MMA栓塞2例，经BA栓塞1例；采用球囊栓塞8例，弹簧圈2例，球囊结合弹簧圈2例。术后随访3-6个月，所有患者无并发症，症状、体征消失，达完全治愈；平均随访（60．2±26．8）个月无复发。结论cd-CAVF血供源于海绵窦壁周围血管直接破裂，易出现“盗血”，经眼上静脉、岩下窦引流多见。经动脉球囊栓塞治疗复杂cd—CAVF效果良好，联合多动脉人路弹簧圈栓塞为有效的补充方法。Objective To analyze the vascular architecture characteristics of the complex direct cavernous arteriovenous fistula （cd-CAVF） and to discuss its treatment and the curative effect of interventional embolization. Methods The hospitalization records, imaging features and operation records of 12 patients with cd-CAVF were retrospectively analyzed. Results In the 12 patients with cd-CAVF, the lesion＇s blood supply arteries included internal carotid artery （ICA,n=8）, primary trigeminal artery （PTA,n=I）, middle cerebral artery （MMA,n=2） and basilar artery （BA, n=1 ）. Different degrees of ＂arterial steal＂ phenomenon could be observed in all patients. The drainage routes included the superior ophthalmic vein and the inferior petrosal sinus （n=10）, and cortical vein （n=2）. Interventional embolization was carried out via ICA （n=4）, through both ICA and BA （n=5）, through MMA （n=2）, or through BA （n=l）. For the embolization of the lesion the balloons were used in 8 patients, steel coils were adopted in 2 patients, and balloons together with coils were employed in 2 patients. All the patients were followed up for 3-6 months. After the treatment the clinical symptoms and signs disappeared, and the lesions were completely cured in all patients with no complications. During the follow-up period of （60.2±26.8） months no recurrence of CAVF was observed. Conclusion The blood supply of cd-CAVF comes directly from the rupture of the blood vessels surrounding the cavernous sinus wall, the ＂arterial steal＂ phenomenon is prone to occur, and the drainage via the superior ophthalmic vein and the inferior petrosal sinus is more often seen. Transarterial balloon embolization is very effective for the treatment of cd-CAVF, and the use of coils together with multi-artery approaches is an effective supplementary method.（J Intervent Radiol, 2015, 24： 750-753）

关 键 词：海绵窦 动静脉瘘 血管内治疗 放射学 介入 

分 类 号：R653[医药卫生—外科学]