经动脉入路栓塞硬脑膜动静脉瘘中的辅助超选技术

The accessory super-selective techniques in performing the transarterial embolization of intracranial dural arteriovenous fistulas

目的探讨经动脉入路栓塞治疗颅内硬脑膜动静脉瘘(DAVF)过程中,微导管常规技术超选失败情况下的辅助超选技术。方法 4例前颅底DAVF、1例天幕区DAVF采用球囊临时阻断颈内动脉以辅助微导管超选;1例天幕区DAVF采用弹簧圈闭塞枕动脉远端以辅助微导管超选。结果采用辅助技术后,6例患者微导管均成功超选到达或接近瘘口,注射Onyx-18胶后,栓塞材料均顺利穿透瘘口,进入并闭塞近端引流静脉。6例患者均一次性获得影像学治愈,术后未发生手术相关并发症。结论初步经验表明,在经动脉入路栓塞颅内DAVF治疗中,对常规技术超选难以到达或接近瘘口的病例,球囊临时阻断颈内动脉和弹簧圈闭塞瘘供血动脉远端分支动脉以辅助微导管超选的技术安全、有效,可作为微导管超选的辅助方法。

Objective To evaluate the assistant techniques in performing transarterial embolization of intracranial dural arteriovenous fistulas（DAVF） when routine super-selective catheterization with microcatheter fails.Methods Temporary balloon occlusion of the parent artery was adopted in 4 cases of anterior fossa DAVF and in one case of tentorial DAVF,and permanent occlusion of the distal main trunk with coils was carried out in one tentorial DAVF in order to help the super-selective catheterization.Results The microcatheter was successfully advanced to,or near,the nidus with the help of these assistant techniques and all 6 cases were cured with single session.After the surgery no operation-related complications occurred.Conclusion Our preliminary results indicate that the assistant techniques,including temporary balloon occlusion of the parent artery and permanent occlusion of the distal main trunk with coils,are a safe and effective method which can reliably help the successful performance of microcatheter catheterization,it can be safely used in complex cases when routine super-selective catheterization fails.