外伤性颈内动脉海绵窦瘘球囊闭塞术后复发及治疗

Recurrence after endovascular detachable balloon embolization of traumatic carotid cavernous fistulae

目的 探讨可脱球囊栓塞治疗外伤性颈内动脉海绵窦瘘后复发的原因及对策。方法 回顾研究用BALT可脱性乳胶球囊成功栓塞治疗的 2 80例外伤性颈内动脉海绵窦瘘 ,随访时间为 4个月至 5年。结果 2 2例在治疗后复发 ,复发率为 7 9%。复发发生在治疗后 48h至 6个月之间。 6例为单个球囊栓塞后复发 ;1 6例为 2枚 (或以上 )球囊栓塞后复发。 1 6例为球囊破裂或早泄引起 ;6例为球囊移位。 2 0例再次用球囊等成功闭塞 ,2例再次复发 ,并行第三次球囊结合弹簧圈闭塞成功。结论 用BALT球囊栓塞的颈内动脉海绵窦瘘有一定的复发率 ,其发生原因可能与球囊本身的质量、球囊的充盈状态、瘘口及球囊停放的位置以及有无颅底骨折等有较大的关系。复发后的并发症有时非常严重 。

Objective To investigate the factors and strategy of recurrence after embolization of traumatic carotid cavernous fistulae(TCCF) with endovascular detachable balloon(DB).Methods We reviewed 280 cases of TCCF embolized with DB with preservation of the internal carotid artery. Follow ups ranged from 4 months to 6 years. Results Twenty two cases recurred after embolization, the recurrence rate was 7 9%. The recurrence occurred from 48hrs to 6 months after treatment. Among the 22 recurred cases, 16 were with the cause of balloon ruptured or deflated early and 6 with ballon moved. 20 cases cured by re-embolization with DB, the other 2 cases recurred again and successfully occluded by combination with coils and DB.Conclusions Treatment of TCCF with DB has a certain recurrence rate. It suggested that the recurrent factors may be related to the balloon quality, inflated condition and displayed position, the sizes of the fistulae, and basal skull fracture. After recurrence the complications could be very serious and urgently need to be treated.