颈静脉球瘤的DSA表现及术前栓塞治疗

DSA Findings and Preoperative Embolization of Glomus Jugulare Tumors

目的：分析颈静脉球瘤的ＤＳＡ表现，评价栓塞治疗的作用。材料和方法：患者５例（男性３例，女性２例）。采用Ｓｅｌｄｉｎｇｅｒ技术，行超选择性动脉插管并造影；栓塞剂采用明胶海绵颗粒和／或真丝线段，分次缓慢注入栓塞材料，栓塞过程中监测肿瘤血管及供血动脉闭塞情况。结果：５例颈静脉球瘤。ＤＳＡ动脉期表现为颈静脉孔、乳突区或后颅凹大片血管团块影，其间血管婉蜒迂曲，颈外动脉之咽升动脉、耳后动脉、枕动脉为主要供血动脉，颈内动脉脑膜垂体干、椎动脉之脑膜支、小脑后、前动脉可参与供血。实质期肿瘤呈湖状、巢状染色。静脉期２例肿瘤较大者见粗大的引流静脉丛向下引流至颈内静脉。栓塞后肿瘤的供血动脉大多被栓塞，肿瘤染色明显减少或消失。栓塞术后７天内行手术，肿瘤完全或大部分切除。结论：ＤＳＡ是显示颈静脉球瘤供血动脉的最佳方法，根据ＤＳＡ表现，可以准确确定肿瘤的位置和侵犯范围。术前栓塞为手术切除提供了良好条件。

Purpose: To analyse the DSA findings and evaluate the role of preoperative embolization of glomus jugulare lumors. Materiais and Methods: 5 patients(3 male and 2 female) were examined on the GE Advantx DSA system. Under Seldinger technique, superselective catheterization was pcrformed. Particlcs of Gelfoam or silk cutur were used as embolic material. Embolic materials were injected into the supplied arteries carefolly when the embolization was performed. Results: 5 glomus jugulare tumors(3 on the left and 2 on the right)were demonstrated. Arterial phase showed extensive, irregular enlarged tumor vessels within the jugulare fossa, mastoid area or posterior fossa area. Branches of ECA, such as the assending phacyngeal artery, posterior aurricular artery and occipilal arlery were the major conrtributors of the tumor. The meningeal branches of ICA, VA or branches of VA such as PICA, AICA might also supply the tumor. Obvious inhomogcncous tumor stain eould be seen on capillary phase. In 2 cases, there were enlarged veins which drainaged into the internal carotid vein on venous phase. All of the tumors were disvascularized after embolization and were reseeted by surgecy within 7 days. Conclution: DSA is the best way to demonstrate the supply arteries of glomus jugulare tumors, and can define precisely the location and extention of tumors. Preoperation embolization may provide advantage condition for surgery.