经未显影岩下窦入路0nyx-18联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘  

Transvenous embolization of cavernous sinus dural arteriovenous fistulas with Onyx-18 and coils via unopacified inferior petrosal sinus approach

作　　者：陈圣攀 叶明[2] 张鹏[2] 李萌[2] 张鸿祺[2] 凌锋[2] 

机构地区：[1]潍坊医学院临床学院神经外科,山东潍坊261053 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经外科疾病研究杂志》2016年第2期117-120,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨经未显影岩下窦入路使用Onyx-18联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘(CSDAVF)的疗效及未显影岩下窦的探查置管成功率。方法回顾性分析2008年1月至2014年10月,首都医科大学宣武医院神经外科经未显影的岩下窦入路使用Onyx-18联合弹簧圈栓塞治疗的44例CSDAVF患者的临床及影像学资料。结果本组44例岩下窦未显影的CSDAVF患者中,其中40例成功经"股静脉-岩下窦"入路栓塞,未显影岩下窦探查打通成功率为90.9%;4例未显影岩下窦探查失败者改用其他途径栓塞。栓塞后即刻血管造影显示完全栓塞者43例(97.7%),次全栓塞者1例。2例患者术中出现反射性心动过缓的问题,3例出现同侧外展神经麻痹的并发症。术后随访造影可见瘘口全部消失,临床症状治愈42例(95.4%),好转2例。结论经岩下窦入路Onyx-18联合弹簧圈栓塞治疗CSDAVF是首选,并可以获得很高的治愈率;了解岩下窦等血管解剖是探查置管成功的关键,并能够获得较高的成功率。但也要注意降低术中及术后相关问题的发生并给予相应的处理措施。Objective The curative effect of transvenous embolization of cavernous sinus dural arteriovenous fistulas（ CSDAVF） with Onyx-18 and coils via unopacified inferior petrosal sinus approach is discussed and the success rate of exploration and catheterization of unopacified inferior petrosal sinus are investigated.Methods Clinical data and radiographic records of 44 patients who underwent endovascular emboliztion of CSDAVF via unopacified inferior petrosal sinus approach using Onyx-18 and coils between January 2008 and October 2014 in the Neurosurgery Department of Xuanwu Hospital were analyzed retrospectively.Results The femoral vein-inferior petrosal sinus approach was successful performed in 40 of 44 patients,and the success rate of exploration and catheterization of unopacified inferior petrosal sinus was 90.9%.Because of the failure of the exploration of inferior petrosal sinus,4cases switched to other embolization pathways.Immediate angiographic results after endovascular embolization showed complete occlusion in 43 of 44 patients（ 97.7%） and near-complete occlusion in 1 patient.The bradycardic reflex was occurred in 2 patients during operation,and the complication of ipsilateral abducens nerve palsy was occurred in3 patients post-operation.The DSA showed the fistulae were complete occlusion and clinical symptoms were cured in42 patients（ 95.4%） and improved in 1 patient in the post-operative follow-up.Conclusion The inferior petrosal sinus approach is the first choice for embolization of the CSDAVF with Onyx-18 and coils with a high rate of completing occlusion.Grasping the anatomy of the inferior petrosal sinus is the key for the exploration with a high success rate.Much attention should be paid to the decrease of incidence of complications and a proper management of the postoperative problems.

关 键 词：硬脑膜动静脉瘘 海绵窦 岩下窦 液体栓塞剂Onyx-18 

分 类 号：R651.1[医药卫生—外科学]