球囊辅助Onyx胶栓塞前颅底硬脑膜动静脉瘘的效果分析

Analysis of the efficacy of anterior skull base dural arteriovenous fistula with balloon-assisted Onyx glue embolization

目的探讨经不同供血动脉行球囊辅助栓塞前颅底硬脑膜动静脉瘘(DAVF)的安全性和有效性。方法回顾性分析2002年1月至2022年12月首都医科大学宣武医院神经外科采用球囊辅助栓塞的9例前颅底DAVF患者的临床资料。9例患者分别经蝶腭动脉、眼动脉、脑膜中动脉进行球囊辅助Onyx胶栓塞,共10例次。术中以栓塞剂完全闭塞近端引流静脉为即刻治愈性栓塞标准。根据患者的并发症情况评估手术的安全性。术后行临床随访,采用改良Rankin量表评分(mRS)评估患者的临床疗效。通过数字减影血管造影(DSA)检查进行影像学随访,以明确病变有无复发。结果9例患者中,7例达到治愈性栓塞,2例为近全闭塞。9例患者中,1例患者经眼动脉途径栓塞后出现视网膜中央动脉缺血症状,其余8例患者无并发症发生。所有患者均完成临床随访,随访时间为59~127个月。末次随访时mRS为0分7例,1分2例。6例患者完成影像学随访,随访时间为6~71个月,其中1例近全闭塞的患者在血管内治疗3个月余后瘘口自行闭塞;其余5例患者在达到治愈性栓塞后行DSA复查,无一例出现复发。结论对于前颅底DAVF,当微导管难以到达瘘口时,经球囊辅助Onyx胶栓塞是一种可行、有效的治疗方法,且并发症轻微。

Objective To explore the safety and effectiveness of balloon-assisted embolization of anterior skull base dural arteriovenous fistula(DAVF)through dfferent blood supply arteries.Methods The clinical data of 9 patients with anterior skull base DAVF who underwent balloon-assisted embolization at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University from January 2002 to December 2022 were retrospectively analyzed.Nine patients underwent balloon-assisted Onyx glue embolization via the sphenopalatine artery,ophthalmic artery,and middle meningeal artery respectively,with 10 procedures in total.During the operation,complete occlusion of the proximal drainage vein by the embolic agent was considered as the criterion for immediate complete embolization.The safety of the procedure was evaluated based on the patient's comorbidity profile.Clinical follow-up was performed after surgery,and the modified Rankin Scale(mRS)was used to evaluate the clinical outcomes of the patients.Imaging follow-up was performed through digital subtraction angiography(DSA)examination to determine whether the fistulas recurred.Results Seven of the 9 fistulas were completely embolized,and two were nearly completely occluded.One of the nine patients had central retinal artery ischemia after embolization via the ophthalmic artery,while the remaining 8 patients had no complications.All 9 patients were followed up for a period ranging from 59 to 127 months.The mRS was O in 7 cases and 1 in 2.Six patients performed imaging follow-up for a period ranging from 6 to 71 months.More than 3 months later,the patient with near-total occlusion received the examination of DSA,which indicated that the fistula was self-occluded.After complete embolization,5 patients underwent DSA review,and none had recurrence.Conclusion When a microcatheter is unable to reach the fistula in an anterior cranial fossa DAVF,balloon-assisted Onyx embolization is feasible and effective treatment with minor complications.