颈动脉海绵窦瘘血管内治疗技术的探讨  

Treatment of carotid cavernous sinus fistula by therapeutic endovascular technique

作　　者：张尚明[1] 洪景芳[1] 刘海兵[1] 刘峥[1] 王守森[1] Zhang Shangming Hong Jingfang Liu Haibing Liu Zheng Wang Shousen(Department of Neurosurgery, Fuzhou General Hospital of PLA, Fuzhou, Fujian 350025, Chin)

机构地区：[1]福州总医院神经外科,350025

出　　处：《中国微侵袭神经外科杂志》2017年第1期11-13,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：福建省自然基金面上项目(编号:2016J01587)

摘　　要：目的分析颈动脉海绵窦瘘(carotid cavernous fistula,CCF)的动静脉结构特征,探讨CCF的血管内栓塞技术。方法回顾性分析51例CCF病人的临床资料。45例为单侧颈内动脉主干瘘,6例合并颈外动脉分支瘘。48例向眼静脉引流,44例向岩上、下窦引流,13例向皮质引流,5例通过海绵间窦引流。其中41例行可脱性球囊栓塞,4例行动脉途径弹簧圈和(或)Onyx 18栓塞,6例行静脉途径弹簧圈和(或)Onyx 18栓塞。结果术后造影显示:瘘口完全闭塞44例,大部分闭塞7例。5例不完全闭塞病人随访6~12个月,痊愈2例,3例有少量引流。临床随访3~6个月,症状消失49例,2例并发同侧展神经受累。结论 CCF有其独特的血管特点,血管内治疗是有效的方式,应根据其特点选取不同的栓塞途径和材料。Objective To analyze the characteristics of arterial and venous structures and investigate the endovascular techniques for carotid cavernous sinus fistula（CCF）. Methods Clinical data of 51 CCF patients were analyzed retrospectively, including 45 with fistula in the unilateral internal carotid artery trunk and 6 with fistula in the branch of the external carotid artery. The fistula drained into the ophthalmic vein in 48 patients, into the inferior and superior petrosal sinuses in 44, into the cortical veins in 13, and into the intercavernous sinus in 5. The detachable balloon embolization was performed on 41 patients, coils and/or liquid embolic material（ Onyx18） via arterial approach on 4 and coils and/or liquid embolic material（ Onyx18） via venous approach on 6. Results The postoperative DSA showed fistulas were totally occluded in 44 patients and partially occluded in 7. Five patients with partial occluion were followed up for 6 to 12 months, 2 recovered and 3 had little drainage. Clinical follow-up period were 3 to 6 months, the symptoms disappeared in 49 patients and 2 suffered ipsilateral abducent nerve disorders. Conclusions There are unique characteristics in vascular structure of CCF. Endovascular embolization is an effective method and the material and approach are chosed according to the characteristics.

关 键 词：颈动脉海绵窦瘘 血管栓塞治疗 球囊 可脱性 弹簧圈 

分 类 号：R743[医药卫生—神经病学与精神病学] R651.2[医药卫生—临床医学]