微弹簧圈和NBCA栓塞难治性外伤性颈动脉海绵窦瘘

Embolization of refractory traumatic carotid cavernous fistula with NBCA and microcoils

目的 探讨微弹簧圈和α 氰基丙烯酸正丁酯 (NBCA)栓塞外伤性颈动脉海绵窦瘘的适应证和方法。方法 回顾 14例外伤性颈动脉海绵窦瘘 ,包括球囊不能完全闭塞瘘口 ,颈动脉已经结扎 ,或瘘口过小球囊不能进入瘘口的病例。 12例因为球囊栓塞失败的病例以微弹簧圈栓塞海绵窦瘘 ,2例球囊和弹簧圈不能完全闭塞瘘口的病例以NBCA栓塞。结果 12例选择弹簧圈栓塞海绵窦 ,8例完全闭塞瘘口 ,复查无复发。 4例大部分闭塞并残余小的瘘口 ,有 1例合并鼻衄 ,术后仍有小量鼻衄发生 ,由耳鼻喉科永久性填塞蝶窦防止鼻衄。 2例NBCA栓塞的病例 ,栓塞后部分闭塞瘘口 ,复查瘘口缩小继而闭塞。结论 在球囊栓塞失败或难度大的病例 ,弹簧圈和NBCA在一定程度上可以弥补球囊的不足 。

Objective To investigate the indications and methods of embolization of refractory traumatic carotid cavernous fistula with microcoils and N byty1 2 cyanoacrylate (NBCA). Methods A total of 14 special cases of traumatic carotid cavernous fistula, including the cases with ligate carotid artery, cases incompletely blocked by balloons, or cases with small fistula unfit to detachable balloons were analyzed retrospectively. 12 cases were embolized with microcoils because of failure of balloons. The other 2 cases were treated with NBCA because of incompletely embolization with balloons and clils. Results Among the 12 cases embolized with coils,8 cases were completely embolized, and there was no recurrence in follow up studies. Four in 12 cases were near completely blocked. Epistaxis of one case could not be stopped and spenoid sinus was blocked permanently in order to stop the epistaxis. The rest two cases were incompetely obliterated with NBCA. The fistulas were gradually minimized and eventually blocked. Conclusions Microcoils and NBCA can make up the disadvantage of detachable balloons in some special cases and get the good clinic results. for the refractory traumatic CCF.