外伤性脑动静脉瘘的血管内治疗

Endovascular treatment of traumatic cerebral artenovenous fistula

目的 探讨外伤性脑动静脉瘘的诊断及鉴别诊断。治疗方法选择及栓塞技术要点。方法对我院1995至2001年收治的125例外伤性脑动静脉瘘患者进行全脑血管造影检查,其中颈动脉海绵窦瘘（CCF）98例,硬脑膜动静脉瘘（DAVF）27例。CCF患者经股动脉入路以球囊栓塞瘘口93例,经股静脉入路以微弹簧圈栓塞4例,经眼上静脉入路以微弹簧圈栓塞1例;27例DAVF,单纯压迫颈动脉法治疗3例,栓塞治疗24例。24例中,可脱性球囊栓塞脑膜中动脉2例,经动脉途径用聚醋酸乙烯酯（PVA）、α-氰基丙烯酸正丁酯（NBCA）胶及冻干硬膜等微粒栓塞21例次,弹簧圈栓塞4例次;经静脉途径弹簧圈栓塞6例次。结果CCF患者95例1次栓塞成功,3例于第一次栓塞后球囊泄漏复发,经再次栓塞治愈,治愈率100％;DAVF患者治愈21例,好转5例,无效1例,治愈率为77.8％,总有效率为96.3％。结论 全脑血管造影可明确诊断,正确选择栓塞途径及栓塞材料是手术成功的关键。栓塞治疗首先选择动脉入路,如果动脉入路治疗失败,则可通过股静脉或眼静脉入路。

Objective To evaluate 125 cases of traumatic cerebral arteriovenous fistula. The characters of clinical diagnosis and treatment were discussed. Methods The DSA were performed in 125 cases. Of them, 98 cases were carotid cavernous fistula (CCF) , 27 cases were dural arteriovenous fistula (DAVF). For 98 cases of CCF, 93 cases were embolized by femoral arterial approach with detachable balloons, 4 cases were embolized by femoral vein approach using electrolytically detachable coils, 1 case was embolized via the superior ophthalmic vein using electrolytically detachable coils. For 27 cases of DAVF, 3 cases were managed by way of compression of the affected carotid artery, 24 cases were treated by embolization. Of 24 cases, 2 were embolized by femoral arterial approach with detachable balloons. By femoral arterial approach embolizations were performed 21 times with PVA particles and NBCA, 4 times with electrolytically detachable coils. By femoral vein approach 6 cases were embolized using electrolytically detachable coils. Results The cure rate of CCF was 100%. Of the 27 patients with DAVF, 21 cases were completely cured, the symptoms of 5 cases were significantly improved, no effect in 1 case. The cure rate of DAVF was 77. 8% , the effective rate of DAW was 96. 3%. Conclusion The diagnosis of arteriovenous fistula depends chiefly on cerebral angiography by DSA. The key of operation is to chose the best embolization materials and good approach. First of all, the embolization should be performed by femoral arterial approach, or by femoral vein approach if it failed by femoral arterial approach.