经眼上静脉介入治疗海绵窦区硬脑膜动静脉瘘

Superior ophthalmic vein approach for endovascular treatment of dural cavernous sinus fistulas

目的探讨眶上内侧缘切开穿刺眼上静脉介入栓塞海绵窦区硬脑膜动静脉瘘(AVF)的方法和疗效。方法眶上内侧缘切开穿刺眼上静脉使用微弹簧圈介入栓塞海绵窦区硬脑膜AVF16例。结果所有患者均临床治愈,1例虽将海绵窦致密填塞,但仍有少量翼丛引流,压颈1个月后消失。栓塞术后并发症主要表现为头痛和呕吐。2例术后出现轻度复视,后自行恢复,无一例出现永久性介入相关并发症。临床随访5个月到6年,患者均无临床症状复发。结论眶上内侧缘切开穿刺眼上静脉入路介入栓塞是海绵窦区硬脑膜动静瘘治疗安全有效的方法之一。

Objective To investigate the method for surgical exposure the superior ophthalmic vein with embolization of the cavernous sinus dural arteriovenous fistula and evaluate its efficacy and safety. Methods Surgical exposure of the superior ophthalmic vein was performed by eyelid incision and followed by catheterization and embolization with micro-coils for 16 patients with cavernous sinus dural arteriovenous fistulas. Results Clinical cure was achieved in all patients and complete angiographic obliteration of fistula was documented in 15 patients （94%）. Residual fistula was left in 1 patients with compact occlusion via pterygoid drainage but disappeared one month later by manual compression of the carotid artery. Headache and vomitting were the most common symptoms after the embolization, other 2 patients had mild diplopia and relieved within two months. No permanent procedure-related morbidity and recurrence occurred during clinical follow up for 5 months to 6 years. Conclusion Surgical exposure of the superior ophthalmic vein for embolization of cavernous sinus dural arteriovenous fistula is a safe and efficient method. （J Intervent Radiol, 2007, 16.. 363-366）