自发性海绵窦区硬脑膜动静脉瘘血管内治疗单中心临床研究

Single center clinical study of endovascular treatment of spontaneous cavernous sinus dural artefiovenous fistula

目的探讨自发性海绵窦区硬脑膜动静脉瘘(SCS-DAVF)患者的临床特点以及血管内治疗的手术方法和策略。方法选取自2012年6月至2020年12月北部战区总医院神经外科收治的29例SCS-DAVF患者为研究对象。分别经股动脉-供血动脉、股静脉-岩下窦、股静脉-面静脉-眼静脉以及股静脉-对侧岩下窦(或眼静脉)-对侧海绵窦-海绵间窦入路,采用弹簧圈和(或)onyx胶材料进行海绵窦栓塞,并闭塞瘘口。观察并记录患者的手术效果、术后并发症及随访结果。结果29例患者中,27例(93.1%)成功完成手术,且全部采用可脱弹簧圈和(或)onyx胶栓塞,其中,应用弹簧圈联合onyx胶21例(77.8%),单纯应用onyx胶5例(18.5%),单纯应用弹簧圈1例(3.7%);采用经股静脉入路栓塞22例(81.5%),经动脉入路栓塞5例(18.5%)。手术患者中瘘口完全栓塞24例(88.9%);次全栓塞3例(11.1%),其中1例通过间断压颈动脉半年后复查数字减影血管造影发现瘘已消失。所有患者术后症状均获明显改善,手术有效率100.0%。5例(18.5%)出现一过性手术相关并发症,无永久性并发症。对进行栓塞手术的27例患者随访3~24个月,其中,术后6~12个月行数字减影血管造影或磁共振成像随访11例,均完全栓塞,未见复发。术后24个月时,失访4例;经门诊面诊或电话随访23例,均未再发相关症状。术后6个月时改良Rankin量表评分0分25例,1分2例。结论对于SCS-DAVF患者采取个性化的血管内治疗策略,可以获得满意的临床效果。

Objective To investigate the clinical characteristics,surgical methods and strategies of endovascular treatment of spontaneous cavernous sinus dural artefiovenous fistula(SCS-DAVF).Methods A total of 29 SCS-DAVF patients admitted to the department of neurosurgery of General Hospital of Northern Theater Command from June 2012 to December 2020 were selected as the study subjects.The cavernous sinus was embolized by spring coil and/or onyx glue through femoral artery-supplying artery,femoral veno-subpetrosal sinus,femoral veno-facial veno-ophthalmic vein,and femoral veno-contralateral subpetrosal sinus(or ophthalmic vein)-contralateral cavernous sinus and intercavernous sinus,respectively,and the fistula was occluded.The results of operation,postoperative complications and follow-up were observed and recorded.Results Of the 29 patients,27(93.1%)were successfully operated with detached-coil and/or onyx glue embolization,including 21(77.8%)with spring coil combined with onyx glue,5(18.5%)with onyx glue alone,and 1(3.7%)with spring coil alone.Twenty-two cases(81.5%)were embolized via femoral vein and 5 cases(18.5%)were embolized via arterial approach.Total fistula embolization was found in 24 patients(88.9%).Subtotal embolization occurred in 3 cases(11.1%),among which 1 case was found to have disappeared by digital subtraction angiography after six months of intermittent carotid artery pressure.The postoperative symptoms of all patients were significantly improved,and the effective rate was 100.0%.There were 5 cases(18.5%)with complications related to one-time surgery,and no permanent complications.Twenty-seven patients who underwent embolization were followed up for 3 to 24 months.Among them,11 patients were followed up by DSA or magnetic resonance imaging 6 to 12 months after operation.All patients were completely embolized without recurrence.At 24 months postoperatively,4 cases were lost to follow-up.Twenty-three cases were followed up by outpatient or telephone,and none of them had recurrence of related symptoms.The modified Rankin scale scored 0 in twenty-five patients and 1 in two patients 6 months after operation.Conclusion Individualized intravascular treatment strategies can achieve satisfactory clinical outcomes for SCS-DAVF patients.