Onxy胶栓塞颈外动脉分支为主要供血海绵窦区动静脉瘘的临床研究

Clinical study of main blood-supply cavernous sinus dural arteriovenous fistulas for embolization of the branches of external carotid artery with Onyx

目的 探讨经动脉入路Onyx胶栓塞治疗颈外动脉分支为主要供血的海绵窦区硬脑膜动静脉瘘（CSDAVF）的可行性、并发症和疗效.方法 回顾性分析2005年8月至2014年10月收治的15例（其中北京天坛医院神经介入科13例,榆林市第二医院神经外科2例）Onyx胶栓塞治疗颈外动脉分支为主要供血的CSDAVF的临床资料和随访结果.结果 术后即刻造影提示12例完全栓塞,3例瘘口部分残留.术后眼部症状缓解14例,并发同侧面部麻木3例,面瘫1例,复视1例.随访3 - 24个月,造影结果提示13例完全治愈,1例造影提示复发行二次栓塞治疗,1例残留较前无变化.临床随访提示眼部症状均缓解,无出血,并发症状均缓解.结论 经颈外动脉分支入路微导管可到达瘘口的CSDAVF,Onyx胶栓塞治疗CSDAVF是可行的,是经静脉入路不能到位或者治疗失败后的替选方案.

Objective To investigate the feasibility,complications and efficacy of main blood-supply cavernous sinus dural arteriovenous fistulas （CSDAVFs） for the embolization treatment of the branches of external carotid artery with Onyx via artery approach.Methods The clinical data and follow-up results of 15 patients （13 patients from the Neurointerventional Department of Beijing Tiantan Hospital and 2 patients from the Department of Neurosurgery,the Second Hospital of Yulin） treated with the main blood-supply CSDAVFs for the embolization treatment of the branches of external carotid artery with Onyx from August 2005 to october 2014 were analyzed retrospectively.Results Immediately after procedure,angiography revealed that 12 patients were embolized completely,3 had partially residual fistula.The postoperative ocular symptoms of 14 patients were relieved,3 complicated with ipsilateral facial numbness,one had facial paralysis,and one had diplopia.They were followed up for 3 to 24 months,angiographic findings revealed that 13 patients were cured completely,one had recurrence and received the second embolization,and the residue did not have any change in one case.The clinical follow-up showed that their ocular symptoms were all relieved,no hemorrhage was observed,and all the complications were relieved.Conclusions Microcatheter can reach CSDAVFs of fistula via the branches of external carotid artery approach.Onyx embolization of CSDAVFs is feasible.It is an alternative scheme which the microcatheter can not be in place via venous approach or after treatment failure.