n—BCA胶在介入治疗创伤性颈动脉海绵窦瘘中的应用

Endovascular treatment of traumatic direct carotid cavernous fistulas with n - Butyl - 2 -Cyanoacrylate

目的 探讨应用n-BCA胶介入栓塞创伤性颈动脉海绵窦的方法和安全性.方法 回顾性分析应用液体胶介入栓塞治疗的11例创伤性颈动脉海绵窦瘘的患者,包括临床特点、治疗方法和疗效.结果 本组11例患者中,因球囊移位或渗漏导致的栓塞术后复发3例;球囊或弹簧圈栓塞后瘘口残留4例;瘘口太小球囊无法进入海绵窦内3例;因碎骨片反复刺破球囊1例.栓塞所使用的n-BCA胶的浓度从25%～50%,其中4例在注胶过程中使用不可脱球囊经颈内动脉暂时封闭瘘口,7例没有采用保护措施.4例采用保护性球囊的患者中均无n-BCA粘住球囊或微导管,所有11例患者均无n-BCA胶返流入颈内动脉的现象,术后即刻造影均提示瘘口完全消失.1例患者术后出现患侧玻璃体出血,经手术清除积血后视力恢复;1例术后出现患侧外展神经麻痹,半年后自行恢复;1例伴有外伤性视神经损伤,术后视力未恢复,无其他介入相关并发症.临床随访3个月-5年,所有患者均无临床症状复发,均恢复正常生活.结论 单独采用n-BCA胶或联合球囊或弹簧圈介入栓塞创伤性颈动脉海绵窦瘘是安全、有效的方法.

Objective To explore the method and safety of endovascular treatment of traumatic direct carotid cavernous fistulas with n - Butyl - 2 - Cyanoacrylate. Method A total of 11 patients with traumatic direct carotid cavernous fistulas treated by endovascular embolization with n - Butyl -2 - Cyanoacrylate（ n - BCA ） were retrospectively analyzed, including the clinical presentations, methods of treatment and results of follow - up. Results In the 11 patients treated with n - BCA embolization, 3 with recurrent fistula because of premature balloon deflation or migration,4 with residual fistula after the balloons or microcoils detached, 3 unable to guide balloon into the small fistulous orifice and 1 repeated puncture of the detachable balloon by the bony fragment. The concentration of n - BCA ranged from 25% to 50%,protective balloon was used in 4 cases and there was no adhesion fo the n - BCA to the protective balloon or the microcatheter or n - BCA reflux into the parent arteries. Complete angiographic obliteration was documented in all patients right after the embolization. There was no permanent procedure - related morbidity. Clinical cure was achieved in all case and the clinical follow - up period ranged from 3 months to 5 years, all the patients restored to their normal life. Conclusions Endovascular embolization with n - BCA is a safe,efficient method for the treatment of traumatic direct carotid cavernous fistulas when angiographic cure and parent artery preservation are not achieved by detachable balloon embolization.