动脉入路横窦-乙状窦区硬脑膜动静脉瘘栓塞术的血管选择

Vascular choice in arterial route of transverse-sigmoid sinus dural arteriovenous fistula embolization

目的探讨横窦-乙状窦区硬脑膜动静脉瘘介入栓塞手术的血管选择。方法7例横窦一乙状窦区硬脑膜动静脉瘘患者，分型1Ib型3例，Ⅳ型4例。均行经动脉途径使用0nyx-18栓塞治疗，0nyx-18注入量最少0．15ml，最多为11ml。其中1例选择脑膜中动脉和脑膜后动脉，1例选择脑膜中动脉和枕动脉，4例患者单独选择脑膜中动脉，1例单独选择枕动脉。结果本组患者完全栓塞6例，1例残余枕动脉少许供血，血流明显减慢。7例患者门诊或电话随访2～12个月，均未再次颅内出血。结论通过分析供血动脉走行、长度及潜在危险吻合，选择合适供血动脉进行栓塞，在微导管到达合适的位置时，正确的注射0nyx-18，通过单一供血动脉或较少供血动脉，可将整个横窦-乙状窦区硬脑膜动静脉瘘的瘘口、静脉湖及引流静脉填塞．达到完全治愈。脑膜中动脉是部分横窦-乙状窦区硬脑膜动静脉瘘介入栓塞时较理想的选择。

Objective To investigate vascular choice in the transverse sigmoid sinus dural arteriovenous fistula embolization operation. Methods Seven cases of transverse sigmoid sinus dural arteriovenous fistula were selected, H b 3 cases, IV 4 cases. All patients were treated with arterial route embolization treatment with Onyx-18 ,at least 0.15 ml and most 11 ml. Among them one case chose the middle meningeal artery and posterior meningeal artery,one case chose the middle meningeal artery and the occipital artery,four cases only chose the middle meningeal artery,one case only chose the occipital artery. Results Six cases were completely occluded, one case left a little blood supply of occipital artery,and the blood flow slowed down. Seven patients were followed-up by outpatient service or telephone for 2-12 months,non of them had intracranial hemorrhage again. Conclusion Through analyzing the shape, length and potential risk of feeding artery, selecting the appropriate artery for embolization,putting the micro catheter in the right place,selecting the right injection of Onyx-18,a single artery or less artery can embolize the entire dural arteriovenous fistula, venous lake and draining vein of transverse-sigmoid sinus. The middle meningeal artery is an ideal choice in part of transverse-sigmoid sinus dural arteriovenous fistula emholizations.