外伤性颈内动脉海绵窦瘘的诊断与介入栓塞治疗(附4例报告)

Diagnosis and Interventional Embolization Therapy for the Traumatic Carotid-cavernous Fistula

目的探讨外伤性颈内动脉海绵窦瘘的诊断和血管内治疗。方法对有头部外伤病史及典型临床表现的患者积极行数字减影血管造影(digital subtraction angiography,DSA)检查,有4例确诊后经股动脉入路,用可脱性球囊进行栓塞治疗。3例保持了患侧颈内动脉的通畅,1例行瘘口远近端的颈内动脉闭塞术;3例患者应用1个球囊,1例应用2个球囊。结果 4例患者瘘口完全闭塞,临床症状缓解,1例于首次术后12 h症状再发,再次行栓塞治疗后缓解痊愈。结论 DSA检查是诊断颈内动脉海绵窦瘘的金标准;可脱性球囊栓塞治疗是颈内动脉海绵窦瘘的首选治疗方法。

Objective To explore the diagnosis and endovascular treatment of the traumatic carotid - cavernous fistula. Methods The digital subtraction angiography （DSA） was checked and detachable bal- loon embolization was treated for the patient with a history of head trauma and the typical clinical presentation. There were 4 cases confirmed after transfemoral artery approach. Results 4 cases of fistula had total occlu- sion and the clinical symptom relief, but 1 case received a second embolization therapy for the recurrence after 12 hours. Conclusion DSA inspection is the gold standard for the diagnosis of the internal carotid artery- cavernous fistula. And the detachable balloon embolization is the preferred method in the treatment of carotid- cavernous fistula.