海绵窦硬脑膜动静脉瘘的DSA分析与栓塞治疗

DSA analysis and embolization therapy of dural arteriovenous fistulas involving cavernous sinus

目的探讨海绵窦硬脑膜动静脉瘘的DSA表现与血管内治疗技术。方法13例患者采用股动脉入路，行选择性颈内、外动脉造影明确诊断后，以聚乙烯醇颗粒和明胶海绵颗粒作为栓塞剂，对9例海绵窦硬脑膜动静脉瘘患者施行颈外动脉硬脑膜支供血的瘘口及供血动脉末梢超选择性栓塞。结果DSA主要表现为患侧海绵窦扩大和眼上静脉扩张。13例海绵窦瘘主要通过眼上静脉引流；3例有不同程度“偷流”现象；9例患者均成功地闭塞了颈外动脉分支向海绵窦分流的瘘口，同时保持了颈外动脉非供血分支的通畅，所有患者临床症状体征明显改善，随访9～12个月未见复发。结论血管内栓塞技术是治疗海绵窦硬脑膜动静脉瘘的最好方法，具有微创、安全和疗效确切的优点。超选择性血管造影诊断及栓塞剂颗粒大小适当是栓塞成功的重要条件。

Objective To explore the DSA features and endovascular treatment technique of dural arteriovenous fistulas involving cavernous sinus. Methods Superselective external and internal carotid angiographic diagnosis was performed using transfemoral approach in 13 cases with dural arteriovenous fistulas involving cavernous sinus. Embolization with polyvinyl alcohol particles and gelfoam particles of fistulous orifice-feeding arteries from external carotid artery was performed in 9 cases. Results The main manifestations on DSA were enlarged cavernous sinus and enlarged superior ophthalmic vein. In 13 cases, superior ophthalmic vein was the main draining vein, 3 cases showed signs of steal. Fistula lous orifice-feeding arteries were successfully embolized with external carotid remaining patent in 9 cases. Satisfactory results were achieved. No recurrence was noted in 9-12 months follow-up. Conclusion Being less invasive, more safe and effective, endovascular embolization is the best method for dural arteriovenous fistulas involving cavernous sinus. Superselective angiographic diagnosis and appropriate embolic particles size are important.