经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘

Transvenous embolization of cavernous sinus dural arteriovenous fistulaes

目的探讨经静脉入路治疗海绵窦区硬脑膜动静脉瘘（CSDAVF）的最佳方法。方法回顾性研究19例经静脉入路栓塞治疗CSDAVF的患者，将其分为两组：A组12例，仅应用可脱弹簧圈栓塞治疗；B组7例，应用弹簧圈联合Onyx胶栓塞治疗。本文对治疗后的影像学结果、并发症、临床表现和随访结果进行比较分析。结果两组的临床治愈率分别为91．7％和100％，并发症主要有脑神经麻痹、三叉神经痛、脱发等；治疗时间分别为（6．77±2．49）h和（3．75±1．63）h；治疗费用分别为（16．9±4．8）万元和（10．3±5．7）万元。结论Onyx胶结合弹簧圈技术有望安全可靠的替代单用弹簧圈栓塞治疗CSDAVF。

Objective Recently there are two ways for the treatment of CSDAVF through transvenous approach： The detachable coils and Onyx unit detachable coils for the cavernous sinus embolization. This study was aimed to compare the two methods. Method We retrospectively reviewed 19 patients who underwent transvenous embolization for CSDAVFs. The patients were divided into 2 groups： group A, patients that had been treated with detachable coils ; group B, patients that had been treated with a combination of detatchable coils and Onyx. The angiographic results, complications, clinical presentations and follow- up results were assessed for both groups. Results In beth groups, excellent outcome was achieved in 91.7% vs 100% （Group A vs Group B）. The main complications were cranial nerve palsy, prosopalgia and alopeeia. In both groups, the duration of one procedure was （6. 77 ± 2. 49 ） hours vs （ 3.75 ± 1.63 ） hours with coiling vs Onyx, and the cost of a procedure was （ 169. 1 ± 48. 1 ） thousand yuan vs （ 103. 3 ± 56. 8 ） thousand yuan. Conclusion Transvenous embolization with the combinationg of Onyx and coils is safe to alternate detachable coils in the treatment of CSDAVFs.