经动脉途径栓塞海绵窦区硬脑膜动静脉瘘

Transarterial embolization of dural carotid-cavernous fistulas

目的探讨经动脉途径介入栓塞海绵窦区硬脑膜动静瘘的疗效和策略。方法回顾性分析经动脉途径介入栓塞治疗的19例海绵窦区硬脑膜动静脉瘘。结果15例临床治愈，3例明显好转，1例治疗失败。其中术后即刻造影提示12例瘘E1完全消失；6例经主要供血动脉栓塞后，经瘘口血流量明显减少，压颈1个月后5例临床治愈，1例症状明显缓解。经动脉治疗失败病例改经岩下窦入路双侧海绵窦微弹簧圈栓塞后治愈。无一例出现永久性介入相关并发症。临床随访7个月到4年，病人无临床症状复发。结论经动脉途径介入栓塞对于部分海绵窦区硬脑膜动静瘘的病人是安全、有效且经济的治疗方法。

Objective To explore the efficacy and strategy of transarterial embolization of dural carotid-cavernous fistulas. Methods The clinical data of 19 patients with dural carotid-cavernous fistulas treated by transarterial embolization, including clinical presentations and patterns of angioarchitecture were retrospectively analyzed. Follow-up was conducted for 7 months to 4 years. Results Clinical cure was achieved in 15 cases, significant improvement of symptoms in 3 cases, and failure in 1 case. Complete angiographic obliteration was documented in 12 patients （63%） right after the embolization. Residual shunting was left in 6 patients, and disappeared in 5 cases one month to half a year later by manual compression of the carotid artery. The patient on which transarterial embolization failed received embolization via the bilateral cavernous later, and clinical cure was achieved. Headache and vomiting were the most common symptoms after embolization. There was no permanent procedure-related morbidity. No recurrence was seen during the follow-up. Conclusion Transarterial embolization is a safe, efficient and economical method for part of the cavernous sinus dural arteriovenous fistula patients.