外伤性颈动脉海绵窦瘘影像学分型的探讨

Traumatic Carotid-Cavernous Fistula; Angiographic Classification and Treatment

目的:探讨一种有利于指导外伤性颈动脉海绵窦瘘(ＴＣＣＦ)诊断和治疗的分型。方法:６５例ＴＣＣＦ均行脑血管造影和血管内治疗,并将其临床表现、影像学和治疗结果进行分析、观察、分型。结果和结论:ＴＣＣＦ可分为３型(Ｉ型:单纯颈内动脉供血;Ⅱ型:颈内动脉颈外动脉均参与供血;Ⅲ型:双侧ＴＣＣＦ和２个亚型(ａ:向前、后、对侧的静脉引流;ｂ:伴有向上引流的混合性引流)。Ｉ型通过颈内动脉即可达到治愈;Ⅱ型需颈内、外动脉联合治疗或静脉入路;Ⅲ型需行双侧瘘口的分别治疗。ｂ型提示潜在的颅内出血,需尽早治疗。

Aim:To investigate a new classification of angiography for traumatic carotid-cavernous fistula (TCCF) .Methods:The clinical files of 65 patients with TCCF confirmed by angiography and treated with intervention were reviewed retrospectively. The relationship among the angiographic features, clinical manifestations and therapeutic results were investigated. Results and Conclusion: According to angiographic characteristics TCCFs could be divided into 3 types and 2 subtypes. In typeⅠthe feeder comes from ICA only (direct fistula). In type Ⅱ the branches from ICA and/or ECA are suppliers (indirect fistula). The bilateral ICA direct fistulae compose type Ⅲ . Each type could further be divided into the following subtypes:subtype a (venous drainage anteriorly to ortib, posterior to petosal and opposite veins) and subtype b (subtype a with venous drainage to leptomeningeal veins) . Type I could be cured by ICA approach only. Both ICA and ECA approach or transvenous obliteration treated type Ⅱ . Type Ⅲ should be treated carefully by bilateral ICA routes respectively. TCCFs with subtype b suggest that the potential risk of intracranial hemorrhage and appropriated interventions should be done as soon as possible.