经动脉采用Onyx-18胶栓塞颅前窝底硬脑膜动静脉瘘

Clinical analysis of anterior cranial fossa dural arteriovenous fistula treated by transarterial embolization with Onyx-18

目的探讨经动脉入路采用Onyx-18胶栓塞颅前窝底硬脑膜动静脉瘘的临床疗效。方法于2004年1月—2009年2月期间,对首都医科大学宣武医院收治的颅前窝底硬脑膜动静脉瘘13例患者(其中男9例,女4例;年龄为36～63岁,平均52岁)应用Onyx-18胶,经动脉进行瘘口及引流静脉栓塞。对其临床资料,包括临床表现、影像学、治疗方法及预后进行回顾性分析。结果①通过单侧眼动脉筛前动脉栓塞8例,通过双侧眼动脉筛前动脉栓塞5例;一次性完全栓塞11例,部分栓塞2例。无严重栓塞并发症。②颈内动脉造影显示,单纯眼动脉筛前动脉供血6例,筛前、筛后动脉供血4例,筛前动脉、筛后动脉、颌内动脉、脑膜中动脉供血3例;异常血流经皮质静脉向上矢状窦汇流9例,伴有向基底静脉汇流3例,合并翼丛面静脉引流1例;引流静脉瘤样扩张或静脉湖形成7例。③术后随访1～48个月,所有病例无再出血及癫痫发作。结论经动脉入路应用Onyx-18胶栓塞颅前窝底硬脑膜动静脉瘘可以获得较好的效果,但疗效及安全性仍需大宗病例和长期随访证实。

Objective To investigate the clinical efficacy of anterior cranial fossa dural arteriovenous fistula embolized via transarterial approach with Onyx-18. Methods Thirteen patients （9 men and 4 women, ranged in age from 28 to 63 years [ mean, 52.0 ] ） with anterior cranial fossa dural arteriovenous fistula admitted to Xuanwu Hospital from January 2004 to February 2009. The patients were treated by transarterial embolization of the fistulous orifice and drainage veins with Onyx-18. Their clinical data, including clinical manifestation, imaging, treatment and prognosis were analyzed retrospectively. Results Internal carotid artery angiography revealed that the fistulae of 6 patients had the blood supply from the anterior ethmoidal artery, 4 patients had the blood supply from both anterior and posterior ethmoi- dal arteries, and 3 patients had the blood supply from anterior and posterior ethmoidal artery, internal maxillary artery and middle meningeal artery, the abnormal blood flow of 9 patients were influxed into superior sagittal sinus through cortical vein, 3 were accompanied with influxing into the basal veins, and 1 accompa- nied with venous drainage from the pterygoid plexus. 7 patients had aneurysmal like dilatation of the drain- age veins or formation of a venous lake. Eight patients underwent embolization through the anterior ethmoidal artery from unilateral ophthalmic artery, 5 patients underwent embolization through the anterior ethmoi- dal artery from the bilateral ophthalmic artery. Eleven patients were embolized completely, and 2 were embolized partially. No serious complications were occurred. Conclusion Transarterial embolization using Onyx-18 can embolize anterior cranial fossa dural arteriovenous fistula satisfactorily. Its efficacy and safety still need to be validated by a large number of cases and long-term follow up.