可脱乳胶球囊血管内治疗外伤性颈动脉海绵窦瘘临床分析

Endovascular treatment of posttraumatic carotidcavernous fistulae using latex detachable balloons

目的探讨可脱乳胶球囊血管内治疗外伤性颈动脉海绵窦瘘的临床应用及手术技巧。方法收集2009年3月至2012年3月收治的采用可脱乳胶球囊血管内栓塞的47例外伤性颈动脉海绵窦瘘患者的临床资料进行回顾性分析。男38例，女9例；年龄17—56岁。瘘口类型均为直接型。47例均存在眼上静脉引流，20例合并同侧岩下窦引流，9例合并岩上窦引流，5例合并岩上窦、岩下窦同时引流，9例经海绵间窦双侧海绵窦引流，4例合并皮层静脉引流。结果45例瘘口采用血管内可脱乳胶球囊技术完全封堵，同侧颈内动脉保持通畅；2例球囊放置困难，经侧支循环评估后采用患侧颈内动脉球囊闭塞术，同时封堵瘘口。患者术后眼部症状均缓解，半年随访期临床症状均消失，无复发。结论可脱乳胶球囊血管内封堵外伤后颈动脉海绵窦瘘安全有效，可使绝大多数直接型瘘口得到理想封堵，并有效减少并发症的发生，复发率低。

Objective To discuss the feasibility, safety, effectiveness and technique of latex detachable balloons in the treatment of traumatic carotid cavernous fistulae （TCCF）. Methods Management and outcome were reviewed for 47 consecutive patients with TCCF treated by latex detachable balloons during 2009 to 2012. Thirty- eight patients were male and 9 patients were female. The age rang was 17 to 56 years old. All patients had superior ophthalmic vein drainage, 20 cases also had ipsilateral inferior petrosal sinus drainage, 9 cases had superior petrosal sinus drainage in combination, 5 cases had superior and inferior petrosal sinus in combination, 9 eases had bilateral cavernous sinus drainage, 4 cases had cortical vein drainage. Results The fistula was occluded in 45 cases with patency of the internal carotid artery. Two fistulas were embolisated by oecluding the internal carotid artery. In all cases, intracranial artery bruit and pulsating exophthalmoses disappeared after occlusion of the fistula. The following- up 6 months showed that all the patients were recovered well. Conclusion Endovascular embolisation with latex detachable balloons is a safe and effective method to treat TCCF, which can deal with the most TCCF and reduce the postoperative complications and recurrence rates.