经静脉入路栓塞治疗横窦-乙状窦区的硬脑膜动静脉瘘

Transvenous embolization of dural arteriovenous fistula involving transverse-sigmoid sinuses

目的评价经静脉入路栓塞治疗横窦-乙状窦区硬脑膜动静脉瘘(DAVF)的安全性和有效性。方法经静脉入路到达患侧的横窦-乙状窦,用微弹簧圈填塞病变静脉窦,同时闭塞瘘口。结果经静脉入路治疗横窦-乙状窦区DAVF共16例。病变累及横窦-乙状窦交界处者11例、横窦者3例、乙状窦者2例。根据Cognard分类,IIa型3例,IIb型1例,IIa+b型12例。单纯应用静脉入路7例,经静脉入路前先采用经动脉途径栓塞者8例,经静脉入路栓塞治疗后再经动脉途径栓塞者1例。瘘口完全闭塞13例,瘘口残留3例,但瘘口流量已减少95%以上。15例(94%)在栓塞治疗后临床症状消失,1例栓塞后出现颅内出血死亡,未见其他并发症。随访4～23个月,临床症状无复发。11例行造影复查:3例残留瘘口者2例消失,1例曾行3次造影复查瘘无明显变化,由于无临床症状,未再行栓塞治疗;另外8例造影复查未见复发。结论对于适当选择的横窦-乙状窦区DAVF病例,经静脉入路闭塞病变静脉窦是一种安全有效的治疗方法。

Objective To evaluate the safety and the efficacy of transvenous embolization of transverse-sigmoid sinus dural arteriovenous fistula(DAVF). Methods The involved cerebral venous sinus was catheterized and occluded with coils via transvenous approach. Results Sixteen patients with transverse-sigmoid sinus DAVF were treated by transvenous approach. In this series, according to the Cognard's classification, there were 3 cases of type IIa DAVF, 1 case of IIb, and 12 cases of IIa+b. Seven cases were treated by transvenous approach alone, 9 cases were treated by both transvenous and transarterial approach. Angiographic cure was achieved in 13 cases, residual shunting was left in 3 cases, but with 95% shunting volume reduction. Clinical cure was achieved in 15 cases. one case died of postprecedural intracranial hemorrhage. There were no other complications. Follow-up period ranged from 4 to 23 months, no reccurence of clinical symptoms were found. Angiographic follow-up was achieved in 11cases. The disappearance of residual shunting was found in 2 of 3, and 1 remained unchanged. There was no angiographic reccurence in the other 8 cured cases. Conclusion In properly selected cases, transvenous occlusion of the DAVF involved transverse-sigmoid sinus was safe and efficient.