动脉瘤性颈内动脉海绵窦瘘的血管内介入治疗

Multimodal endovascular therapy of aneurysmal carotid-cavernous fistulas

目的回顾性分析动脉瘤性颈内动脉海绵窦瘘的诊断及经动脉血管内多方式联合治疗的经验。方法总结分析6例经血管内治疗的动脉瘤性颈内动脉海绵窦瘘资料,6例患者经查体及CT、MR、DSA等确诊,均行经动脉血管内治疗,方法包括可脱球囊闭塞瘘口,可脱球囊联合弹簧圈,应用Onyx胶封堵引流静脉、弹簧圈填塞动脉瘤及覆膜支架辅助治疗,经支架辅助下弹簧圈填塞动脉瘤。结果 1例单纯应用可脱球囊,2例联合应用球囊和弹簧圈填塞,2例应用Onyx胶封堵引流静脉、弹簧圈填塞动脉瘤及支架辅助治疗,1例经支架辅助下弹簧圈填塞动脉瘤;术后随访无手术相关并发症,1例因术前视神经损害导致患眼视力未恢复正常。结论血管内多种方式联合治疗动脉瘤性颈内动脉海绵窦瘘是有效、安全的治疗方法。

[ Objective ] To analyse and summarise the diagnosis and endovascular therapy of aneurysmal carotid- cavernous fistulas. [ Methods ] Retrospectively analysis of 6 cases of aneurysmal carotid-cavernous fistulas treated in our hospital in the last 5 years. DSA showed the aneurysm of the cavernous segment of internal carotid artery, cavernous sinus fistula and the dilated superior ophthalmic vein. 6 cases received endovascular treatment, using detectable balloon alone or combined with the coil,Onyx-18 glue and stent. [ Results ] Multimodal endovascular therapy were used. Detectable balloon alone was used in 1 case. Detectable balloon combined with coil were used in 2 cases.Onyx-18 glue was used in 2 cases to sealing the main drainage venous.Coils and stent wereused in i case. After endovascular intervention contrast, aneurysm, cavernous sinus and superior ophthalmic vein were not developing.Immediate complete angiographic obliteration of the fistulas was achieved. Postoperative follow-up of 3 months found no recurrence. [ Conclusion ] For the ruptured aneurysmal carotid-cavernous fistula in cavernous sinus, combinational endovascular treatment is an minimally invasive, effective and preferred therapy approach.