经静脉途径应用可脱弹簧圈和n—BCA胶栓塞治疗硬脑膜海绵窦瘘

Trausvenous embolization of dural carotid-cavernous sinus fistulas with detachable coils and N-butyl cyanoacrylate

目的探讨经静脉途径栓塞治疗硬脑膜海绵窦瘘（dCCF）的可行性和临床疗效。方法选择6例单侧自发性dCCF患者，均经脑血管造影证实，其中2例合并同侧颈内静脉闭塞。经患侧眼上静脉途径栓塞治疗2例，经患侧岩下窦途径栓塞治疗4例。栓塞材料主要为可脱弹簧圈（2例1，可脱弹簧圈＋n-BCA胶（4例）。结果4例患者栓塞治疗后瘘口完全消失，血管杂音即刻消除，突眼、结膜充血等症状多于1～3d内恢复正常，眼球运动障碍、复视和视力减退恢复稍慢，多于3个月内逐渐恢复正常。1例右侧dCCF患者术后dCCF部分残留，行患侧间歇压迫颈动脉治疗1周后症状消除。另有1例右侧dCCF患者经同侧眼上静脉途径单纯采用可脱弹簧圈栓塞治疗，1个月后再次出现同侧突眼、结膜水肿复发、加重，复查造影见dCCF复发，同侧脑膜中动脉分支供血，再次经动脉途径栓塞治疗后症状消失。所有6例患者栓塞治疗后未出现有症状的并发症。结论经静脉途径栓塞治疗dCCF是一种更为有效和安全的方法，使用可脱弹簧圈结合n—BCA胶可提高填塞海绵窦和闭塞瘘口的成功率。

Objective To evaluate the clinical outcome of transvenous embolization with detachable coils and N-butyl cyanoacrylate （n-BCA） for management of dural carotid-cavernous sinus fistulas （dCCFs）. Methods Six patients with angiographically confirmed spontaneous dCCF were involved in this study, including two with concurrent ipsilateral internal jugular vein occlusion. All the patients received surgeries for transvenous embolization through the superior ophthalmic vein （2 cases） or the inferior petrosal sinus （4 cases）, using detachable coils （2 cases） or detachable coils combined with n-BCA （4 cases）. Results The vascular murmur, exophthalmos and conjunctival congestion disappeared in 4 patients shortly after the total embolization of the fistulas, while eyeball movement disorder, diplopia and visual deterioration persisted for at least 1 month and gradually recovered 3 months after the surgery. The fistulas failed to be completely embolized in two patients, and in one of the patients, the symptoms resolved after intermittent carotid artery compression for one week; in the other patient, exophthalmos recurred and worsened 1 month after embolization, and was successfully managed with transarterial embolization of the fistula. No symptomatic complications were found in these 6 patients after transvenous embolization in spite of the presence of a few small n-BCA granules in the lungs of two patients. Conclusion Transvenous embolization is safe and effective for management of dCCF, and combined use of detachable coils and n-BCA may enhance the success rate of total fistula embolization.