经不同路径应用Onyx-18胶栓塞治疗前颅窝底硬脑膜动静脉瘘的疗效分析  

Therapeutic effect analysis of embolization of dural arteriovenous fistula at anterior cranial fossa base using Onyx-18 via different approaches

作　　者：张玉华 那世杰[1] 刘涛[1] 庄宗 凌海平 杭春华 张庆荣 Zhang Yuhua;Na Shijie;Liu Tao;Zhuang Zong;Ling Haiping;Hang Chunhua;Zhang Qingrong(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《中华神经外科杂志》2023年第5期456-461,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81971127)。

摘　　要：目的 初步探讨经不同路径应用Onyx-18胶栓塞治疗前颅窝底硬脑膜动静脉瘘(ACF-DAVF)的安全性和有效性.方法 回顾性分析南京大学医学院附属鼓楼医院神经外科2018年11月至2022年1月应用Onyx-18胶栓塞治疗的11例ACF-DAVF患者的临床资料,所有患者术前数字减影血管造影(DSA)显示ACF-DAVF均为Cognard Ⅳ型,根据其供血动脉、引流静脉情况个体化选择经眼动脉、脑膜中动脉镰前支、脑膜中动脉镰前支联合眼动脉及经静脉4种路径进行栓塞治疗,术后即刻行DSA复查并行Class分级评估栓塞效果;分析经不同路径栓塞的治疗效果、并发症及随访结果.结果 11例患者共进行11次栓塞,均顺利完成.其中,经眼动脉入路栓塞5例,Class分级Ⅰ级4例、Ⅱ级1例,1例术后出现迟发性出血;经脑膜中动脉镰前支入路栓塞3例,Class分级均为Ⅰ级,无围手术期并发症发生;经脑膜中动脉镰前支联合眼动脉入路栓塞1例,Class分级为Ⅰ级,术后出现左侧眼眶区疼痛,2 d后症状消失;经静脉入路栓塞2例,Class分级均为Ⅰ级,无围手术期并发症发生.11例患者的随访时间为(11.3±6.1)个月(3~23个月),其中10例行DSA复查,均显示瘘口完全闭塞;1例行头颅磁共振血管成像复查,显示前颅窝底已无异常血管影;末次随访显示,患者术前存在的头痛、头晕、癫痫等临床症状均消失或减轻.结论 初步观察发现,根据ACF-DAVF的供血动脉、引流静脉情况个体化选择不同路径应用Onyx-18胶栓塞治疗,手术成功率高,并发症少,是一种安全、有效的方法.Objective To investigate the safety and efficacy of Onyx-18 embolization via different approaches in the treatment of anterior fossa base dural arteriovenous fistula(ACF-DAVF).Methods A retrospective analysis was conducted on the clinical data of 11 patients who underwent Onyx-18 embolization for ACF-DAVF in the Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,from November 2018 to January 2022.All patients showed ACF-DAVF of Cognard type IV based on preoperative digital subtraction angiography(DSA).Embolization was performed individually through the ophthalmic artery,middle meningeal artery anterior falciform branch,middle meningeal artery anterior falciform branch combined with ophthalmic artery and veins according to the supplying artery and draining vein.DSA review and Class grading were performed immediately after surgery to evaluate the embolization degree.The therapeutic effect,complications and follow-up results of embolization via different approaches were analyzed.Results In 1l patients,a total of 11 embolization procedures were all successfully completed.Among them,5 cases were embolized by ophthalmic artery access,4 cases were Class I,1 case was Class I,and 1 case had delayed bleeding after surgery.Three cases were embolized by middle meningeal artery anterior falciform branch access,all were Class grade I,and no perioperative complications occurred.One case undergoing embolization via the middle meningeal artery anterior falciform branch combined with the ophthalmic artery was Class I and developed pain in the left orbital region after surgery which disappeared 2 days later.Two cases were both embolized by venous access and Class grade I,and no perioperative complications occurred.The follow-up time of the 11 patients was 11.3±6.1 months(3-23 months).Ten patients underwent DSA review which showed complete occlusion of fistula in all cases.One received skull magnetic resonance angiography reexamination which showed no abnormal vascula

关 键 词：动静脉瘘 血管内操作 治疗结果 硬膜 颅窝 前 Onyx-18胶 

分 类 号：R651.1[医药卫生—外科学]