球囊栓塞治疗外伤性颈动脉海绵窦瘘后动眼神经麻痹预后情况及恢复时间影响因素分析

Analysis of factors related to recovery and recovery time of oculomotor nerve paresis caused by traumatic carotid-cavernous fistula after endovascular treatment with detachable balloons

目的探讨由外伤引起的颈动脉海绵窦瘘动眼神经麻痹经球囊栓塞治疗后，影响动眼神经功能恢复时间的相关因素。方法回顾性分析南方医科大学珠江医院神经外科自2005年1月至2012年12月收治的98例经血管内球囊栓塞治疗的外伤性颈动脉海绵窦瘘（TCCF）后动眼神经麻痹患者的临床资料。以性别、年龄、瘘口位置、术前动眼神经麻痹程度、眼突位置、球囊使用数量、颈内动脉状态及术前动眼神经出现麻痹症状到治疗时间为研究因素，采用t检验、方差分析及非参数检验等方法对影响动眼神经麻痹预后时间的相关因素进行分析。结果术后平均随访36月（3-95月），90例（91．8％）患者1次成功栓塞，8例（8．2％）患者于第一次栓塞后4周内球囊泄露复发，经再次栓塞后达到完全治愈。94例患者在闭塞瘘口的同时保留颈内动脉，颈内动脉保留率为95．9％。所有患者动眼神经麻痹症状均得到完全恢复，无并发症及死亡。海绵窦瘘位置，术前动眼神经麻痹程度。球囊使用数量，不同的患者术后动眼神经麻痹恢复时间亦不同，差异有统计学意义（P〈0．05）。结论使用球囊栓塞治疗TCCF所致的动眼神经麻痹，是一种安全有效的治疗方法。

Objective To analyze the factors related to recovery time of oculomotor nerve paresis （ONP） caused by traumatic carotid-cavernous fistula （TCCF） after endovascular treatment with detachable balloons. Methods Ninety-eight patients with ONP caused by TCCF, admitted to our hospital from January 2005 to December 2012 and treated with etachable balloons, were chosen in our study; their clinical data were retrospectively analyzed. The relevant factors which contained gender, age, location of the fistula, degree of preoperative ONP, side of ophthalmoptosis, number of detachable balloons, status of the internal carotid artery （occluded or reserved） and duration of ONP before endovascular treatment were evaluated using independent samples t-test, variance analysis and nonparametric test to analyze the factors related to the prognosis times. Results ONP was complete in 22 patients （22.4%） and partial in 76 patients （77.6%）. Ninety patients （91.8%） were successfully occluded by single-session endovascular embolization; re-treatments by transarterial routes had to be performed in 8 （8.2%） because of recurrent fistula occurring within 4 weeks after embolization. ONP was recovered completely in all the patients, among which 4 （4.1%） were treated with occlusion of internal carotid artery. No other complications or death were noted. Recovery interval of ONP was significantlyassociated with the location of the fistula, degree of preoperative ONP and number of detachable balloon being usedbefore endovascular treatment （P〈0.05）. Conclusion It is a safe and effective method for traumatic carotid-cavernous fistula with ONP using endovascular treatment with detachable balloons.