远端血管阻断辅助微导管超选经动脉入路栓塞硬脑膜动静脉瘘

Microcatheter super-selection assisted by trunk occlusion distal to the origin of the feeding artery:application of the technique in transarterial embolization of dural arteriovenous fistula

目的介绍远端血管阻断辅助微导管超选技术在经动脉入路栓塞硬脑膜动静脉瘘术中的应用。方法硬脑膜动静脉瘘患者2例。1例为天幕缘区硬脑膜动静脉瘘,供血动脉来自脑膜中动脉和枕动脉,采用弹簧圈闭塞枕动脉远端主干。另一例为前颅窝底硬脑膜动静脉瘘,供血动脉为双侧眼动脉之筛前、筛后动脉,采用球囊临时阻断于颈内动脉眼动脉开口远端。结果微导管在弹簧圈及球囊支撑下均超选入与主干血管成角明显且迂曲的供血动脉远端,微导管头端接近瘘口,以液态栓塞材料完全消除瘘口。结论对于供血动脉迂曲且与主干血管成角明显的硬脑膜动静脉瘘,远端血管临时或永久阻断有利于使微导管头端超选至理想位置,最终保证瘘口栓塞。

Objective Tip position of the microcatheter is vital for transarterial embolization of cranial dural arteriovenous fistula （DAVF）. Our experiences were presented that we advanced the microcatheter as near as possible to the nidus by occluding the trunk distal to the origin of the feeding artery. Methods Two cases of DAVF were presented, in which the feeding arteries were difficult to super-select. One of them suffered from tentorial DAVF, ahose occipital artery trunk distal to the feeding artery （dural branch） were blocked by coils. Dural arteriovenous fistula of anterior cranial fossa fed by bilateral ethmoidal arteries was disclosed in the other patient, whose right internal carotid artery just distal to the ophthalmic artery was temporarily occluded by a balloon. Results Microcatheters were advanced through the angulation of the origin of the tortuous feeding arteries, the tip of which were close to the nidus. Then, fistulas were totally obliterated by Onyx injection. Conclusions This technique afforded more control in the microcather advancement and minimized the risk of glue reflux and eventually promoted tot,all obliteration of the fitulas.