经不同动脉途径使用Onyx18栓塞前颅窝底硬脑膜动静脉瘘

Embolization of dural arteriovenous fistula in anterior cranial fossa using Onyx18 via different feeding arteries

目的探讨经不同动脉途径栓塞前颅窝底硬脑膜动静脉瘘的安全性、有效性。方法回顾性分析2004年5月—2012年4月,首都医科大学宣武医院介入放射诊断治疗科使用Onyx18栓塞治疗的前颅窝底硬脑膜动静脉瘘患者的临床资料,共16例,其中男14例,女2例,年龄33～71岁,平均50岁。分析栓塞所选用的不同动脉入路、栓塞的治愈率及并发症的发生率。结果①血管造影显示所有患者的硬脑膜动静脉瘘均由眼动脉的筛前动脉和筛后动脉供血,9例另由脑膜中动脉和蝶腭动脉参与供血,其中2例还伴有额极动脉供血;3例另由蝶腭动脉参与供血。②在16例患者中,1例经蝶腭动脉、8例经脑膜中动脉分支、7例经眼动脉供血的筛前动脉分支进行超选择置管栓塞。所有患者均得到影像学治愈,术后恢复良好。无任何相关并发症的发生。③术后半年门诊随访7例,无任何相关症状;半年影像学随访3例,无影像学复发表现。结论经动脉途径使用Onyx18栓塞前颅窝底硬脑膜动静脉瘘是一种安全、有效的治疗方法。根据供血情况选择合适的供血动脉进行栓塞,可以提高手术的安全性和成功率。

Objective To investigate the safety and effectiveness of the embolization of dural arterio-venous fistula in the anterior cranial fossa. Methods The clinical data of 16 patients with dural arteriove-nous fistula in anterior cranial fossa treated with Onyxl8 in the Department of Interventional Radiology, Beijing Xuanwu Hospital, Capital Medical University from May 2004 to April 2012 were analyzed retrospec-tively. There were 14 males and 2 females, aged 33 to 71 years （mean, 50 years）. The different feeding ar-teries selectedfor embolization, the rate of cure , and the incidence of complications were analyzed. Results ①Cerebral angiography showed that all the patients dural arteriovenous fistula were supplied by both anterior ethmoidal artery and posterior ethmoidal artery of the ophthalmic artery. Nine patients had additional middle meningeal artery and sphenopalafine artery supply, among them 2 had additional frontopolar artery supply; 3 had another sphenopalatine artery supply. ②In the 16 patients, the superselective catheter embolizations were performed and via the branches of sphenopalatine artery in 1 patient, via the branches of middle menin- geal artery in 8 patients, via the branches of anterior ethmoid artery of ophthalmic artery in 7 patients . All patients were proved cure with the imaging and recovered well after surgery. ③There were no any related symptoms in 7 patients during the 6 months outpatient follow-up; 3 patients were followed up via cerebral an-giography for 6 months, no reoccurrence was found . Conclusion Embolization of dural arteriovenous fis-tula in anterior cranial fossa using Onyx18 via arterial approach is a safe and effective method for treatment. According to the blood supply, selecting the appropriate feeding arteries for embolization may improve the surgical safety and success rate.