眼静脉近心端弹簧圈闭塞在海绵窦区硬脑膜动静脉瘘治疗中的疗效和安全性分析  

Efficacy and safety of proximal spring coil occlusion of the ophthalmic vein in cavernous sinus-dural arteriovenous fistulae

作　　者：魏壮壮 马骥[1] 杨杰[1] 王晔[1] 李臻[1] 陈佳佳[2] 王文战[2] 韩新巍[1] 李腾飞[1] Wei Zhuangzhuang;Ma Ji;Yang Jie;Wang Ye;Li Zhen;Chen Jiajia;Wang Wenzhan;Han Xinwei;Li Tengfei(Department of Radiology and Interventional Medicine,Institute of Interventional Therapy,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Ophthalmology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州大学介入治疗研究所,郑州450052 [2]郑州大学第一附属医院眼科,郑州450052

出　　处：《中华神经医学杂志》2023年第10期1010-1015,共6页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81801806);河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029);河南省医学科技攻关重点项目(202301002)。

摘　　要：目的:探讨海绵窦内弹簧圈+Onyx胶栓塞联合眼静脉近心端弹簧圈闭塞治疗海绵窦区硬脑膜动静脉瘘(CS-DAVF)的有效性和安全性。方法:选择郑州大学第一附属医院放射介入科自2018年8月至2022年12月采用海绵窦内弹簧圈+Onyx胶栓塞联合眼静脉近心端弹簧圈闭塞治疗的37例CS-DAVF患者为研究对象,回顾性分析患者的临床资料和疗效。结果:37例患者就诊时均有不同程度眼部症状,包括结膜充血(31例,83.8%)、眼球突出(16例,43.2%)及眶周可闻及明显血管杂音(14例,37.8%)等。37例患者均采用静脉途径(包括岩下窦入路34例,眼静脉入路2例和面静脉入路1例)进行血管内介入治疗。术后即刻DSA显示瘘口完全闭塞31例、近全闭塞6例(同时增粗眼静脉引流消失或明显减慢)。35例患者术后出现患眼不同程度水肿加重后逐渐减轻过程(持续时间1~2周),出院前所有患者眼部充血和血管杂音等症状均消失。4例患者术后出现动眼和外展神经不全麻痹,1~5个月后症状明显好转;1例出现外展神经麻痹同时合并复视,服用营养神经药物2个月后症状减轻。术后随访(12.1±4.4)个月(范围为6.5~21.3个月),末次随访时所有患者眼部充血及水肿症状均消失;术后6个月DSA随访示CS-DAVF均未复发。结论:海绵窦内弹簧圈+Onyx胶栓塞联合眼静脉近心端弹簧圈闭塞治疗CS-DAVF安全、有效。Objective To investigate the efficacy and safety of intracavernous sinus spring coil+Onyx gel embolization combined with proximal spring coil occlusion of the ophthalmic vein in cavernous sinus-dural arteriovenous fistula(CS-DAVF).Methods Thirty-seven patients with CS-DAVF accepted intracavernous sinus spring coil+Onyx gel embolization combined with proximal spring coil occlusion of ophthalmic vein in Department of Radiology and Interventional Medicine,First Affiliated Hospital of Zhengzhou University were selected.The clinical data and therapeutic efficacy of these patients were retrospectively analyzed.Results All 37 patients had different degrees of ocular symptoms at the time of treatment:31(83.8%)had conjunctival congestion,16(43.2%)had exophthalmos,and 14(37.8%)had obvious periorbital vascular murmur.Endovascular intervention was performed in all patients via venous routes,including inferior petrous sinus approach(n=34),ophthalmic vein approach(n=2),and facial vein approach(n=1).Immediate postoperative DSA showed that 31 patients had complete occlusion of the fistula,and 6 patients had near-total occlusion(disappeared drainage of the thickened ophthalmic vein or obviously slowed down drainage).Thirty-five patients had ocular oedema of varied degrees and then gradually reduced(lasting for 1-2 weeks),and all the ocular congestion and vascular murmurs disappeared before discharging from the hospital.Four patients had postoperative palsy of the motor and abducens nerves,which improved significantly after 1-5 months;1 patient had diplopia in combination with abducens nerve palsy;all symptoms alleviated after 2 months of nutritional nerve medication.Follow up in Outpatient Clinic or telephone was performed for(12.1±4.4)months,ranged for 6.5-21.3 months;symptoms of ocular congestion and edema disappeared in all patients at the last follow-up.Followed-up DSA at 6 months showed no recurrence of CS-DAVF.Conclusion Intracavernous sinus spring coil+Onyx gel embolisation combined with proximal spring coil occlusion of

关 键 词：硬脑膜动静脉瘘 眼静脉 血管内介入治疗 弹簧圈 ONYX胶 

分 类 号：R743[医药卫生—神经病学与精神病学]