血管内栓塞治疗海绵窦区硬脑膜动静脉瘘

Endovascular embolization of cavernous sinus-dural arteriovenous fistula

目的评价血管内栓塞(endovascular embolization,EVE)治疗海绵窦区硬脑膜动静脉瘘(cavernous sinus-dural arteriovenous fistula,CS-DAVF)的技术和疗效。方法 2004年1月至2012年12月收治CS-DAVF患者39例,其中单侧病变36例,两侧病变3例。根据供血动脉、瘘口和引流静脉选择不同途径进行EVE治疗。术后1～60个月进行脑血管造影和临床随访评价疗效。结果 EVE治疗中,采用单纯经动脉途径栓塞(transarterial embolization,TAE)12例,单纯经静脉途径栓塞(transvenous embolization,TVE)19例,联合途径栓塞8例。术后即刻造影示28例瘘口完全闭塞,11例瘘口残留。术中1例角静脉破裂出血,术后1例静脉栓塞导致脑梗死。1年复查脑血管造影示35例瘘口完全闭塞,26例患者临床症状完全消失,10例明显改善,1例无明显变化,2例加重。结论 EVE是治疗CS-DAVF重要和有效方法,应首选。对于复杂的CS-DAVF可联合TAE治疗,术后配合压颈提高治愈率。

Objective To evaluate the technique and clinical efficacy of endovascular embolization （EVE） for t cavernous sinus-dural arteriovenous fistula （CS-DAVF）. Methods During the period from Jan. 2004 to Dec. 2012, a total of 39 consecutive patients with CS-DAVF were admitted to the hospital. Unilateral lesion was seen in 36 patients and bilateral lesion in 3 patients. According to the feeding artery, the orifice of fistula and the draining vein of the lesion, different ways of access, i.e. transarterial or transvenous, or combination route catheterization, were used to perform EVE. Cerebral angiography was carried out within 1 60 months after the procedure and the clinical results were evaluated. Results EVE was carried out in all patients. Transarterial embolization （TAE） was employed in 12 patients, transvenous embolization （TVE） was adopted in 19 patients, and TAE together with TVE was used in 8 patients. Cerebral angiography performed immediately after the procedure showed that complete occlusion of arteriovenous fistula was obtained in 28 cases and residual orifice of arteriovenous fistula was detected in 11 cases. Angular vein bleeding during the operation occurred in one case, and postoperative cerebral infarction caused by venous embolism was seen in another case. One year after EVE, follow- up checkups with cerebral angiography showed that complete occlusion of arteriovenous fistula was obtained in 35 cases. Clinically, the symptoms totally disappeared in 26 cases, were obviously improved in 10 cases, remained the same in one case, and became worse in 2 cases. Conclusion EVE is an important and effective treatment for CS- DAVFs, and transvenous embolization should be regarded as the method of first choice in clinical practice. For the treatment of complex CS-DAVFs, transarterial embolization together with transvenous embolization should be recommended, and manual carotid compression after the procedure can further improve the efficacy. （J Intervent Radiol, 2013, 22：451-457）