创伤性颈动脉海绵窦瘘的血管内栓塞治疗

Endovascular embolization for traumatic carotid-cavernous fistula

目的探讨创伤性颈动脉海绵窦瘘(TCCF)的治疗方法、栓塞技术要点及随访意义.方法对119例TCCF病人共行128次栓塞.其中,股动脉入路112例,股静脉入路5例,经眼上静脉入路2例;以球囊栓塞瘘口101例,以微弹簧圈栓塞13例,球囊并用弹簧圈2例,干冻硬脑膜3例.术后3月～10年随访110例,其中行影像学复查29例.结果111例1次栓寒成功,8例于第1次栓塞后球囊泄漏复发,经再次栓塞治愈,总治愈率100%.颈内动脉通畅率90.8%(108/119),无严重并发症,随访显示疗效可靠.结论TCCF一般经股动脉入路用可脱性球囊栓塞瘘口,小瘘口TCCF选择微弹簧圈栓塞;若颈内动脉结扎或闭塞,可经静脉入路栓塞瘘口.一般情况下海绵窦瘘均表现为良性过程,应力争解剖治愈,不可轻易牺牲颈内动脉.正确选择栓塞途径及栓塞材料是手术成功的关键.

Objective To evaluate the choice of approaches, surgical techniques and clinical outcome of endovascular embolization for treating traumatic carotid cavernous fistula (TCCF). Methods A retrospective analysis of 119 patients with TCCF was conducted, in whom totally 128 embolizations were performed. In these procedures, the femoral artery approach was adopted in 112 cases, femoral vein approach in 5 cases, and superior ophthalmic vein approach in 2 cases. For the embolization materials, balloons were used in 101 cases, microcoils in 13 cases, both materials in 2 cases, and lyophilized dura mater in 3 cases. After the embolization procedures, 110 patients were followed-up for 3 months to 10 years, and 29 patients reexamined with angiography. Results Successful embolization for TCCF in a single procedure was achieved in 111 cases, and failure occurred due to balloon leakage in 8 cases, all embolized successfully in a second attempt. The total success rate was 100% in these cases, with a rate of internal carotid artery patency of 90.8% (108/119). No perioperative mortality or complication occurred, nor was TCCF recurrence seen during the follow-up. Conclusions In general, TCCF can be successfully treated by balloon embolization via the femoral artery, while microcoil embolization has better performance for small fistula. Embolization can be done through venous approach when the internal carotid artery is ligated or occluded, and no procedure should be performed at the convenient expense of the internal carotid artery. Right choices of the approaches and embolization materials are key to the success of the procedure.