经面静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘

Embolization treatment of dural arteriovenous fistula in the cavernous sinus region via facial vein approach

目的探讨经面静脉途径治疗海绵窦区硬脑膜动静脉瘘(arteriovenous fistula,AVF)的方法和疗效。方法回顾性分析经面静脉途径(导管置入股静脉-面静脉-角静脉-眼上静脉-海绵窦)治疗7例海绵窦区硬脑膜AVF的病例资料,其中5例患者岩下窦闭塞;1例患者岩下窦开放,但其AVF所在的海绵窦和岩下窦之间无交通;1例患者的瘘与岩下窦相通。对该患者先行经岩下窦栓塞海绵窦后部,然后再经面静脉途径栓塞海绵窦前部。其他6例患者只经面静脉途径行栓塞治疗。结果血管造影显示,7例患者的角静脉和眼上静脉的走行清晰,其中有1例眼上静脉闭塞的患者,由于导管无法置入闭塞的眼上静脉,导致经静脉途径治疗终止。其余6例患者经面静脉入路用弹簧圈栓塞海绵窦治疗后,4例达到完全栓塞,2例临床症状明显好转。结论相对其他静脉途径而言,经股静脉-面静脉入路是血管内治疗海绵窦区硬脑膜AVF的一种很有价值的方法,即使该入路对术者手术技能要求较高,但仍然不失为一种安全和有效的血管内治疗方法。

Objective To investigate the method and efficacy of dural arteriovenous fistula （AVF） in the cavernous sinus region treated via facial vein approach. Methods The facial vein approach was performed by retrograde catheterization of the internal jugular vein - facial vein - angular vein - superior ophthalmic vein - cavernous sinus. The clinical data of 7 patients with AVF in the cavernous sinus region treated via facial vein approach were analyzed retrospectively. Among them, 5 patients experienced sinus occlusion, and 1 experienced the inferior petrosal sinus （IPS） patency, but there was no communication between the cavernous sinus and IPS in the AVF. The fistula of 1 patient connected with IPS. The posterior cavernous sinus were occluded first via IPS, and then the anterior cavernous sinus were occluded via facial vein approach. The other 6 patients were occluded via facial vein only. Results Angiography showed that in 7 patients the course and distribution of the angular vein and SOV were clear. In one patients with SOV occlusion, the transvenous procedure was stopped because of the catheter could not be inserted into the occluded SOV. After the fistulas were occluded with coils via facial vein approach in the remaining 6 patients, 4 were completely occluded, and 2 improved significantly. Conclusion Compared with other intravenous approaches, the endovascular treatment of the dural AVF in cavernous sinus region via femoral vein to facial vein approach is a valuable approach. Even if this approach requires higher operative skills, but it is a safe and effective method for endovascular treatment.