颈内动脉海绵窦瘘的经血管内栓塞治疗

Endovascular embolization of carotico-cavernous fistula

目的:评价颈内动脉海绵窦瘘(CCF)经血管内栓塞治疗的方法及价值。材料和方法:分析14例经血管内介入治疗的颈内动脉海绵窦瘘病例,以带毛弹簧栓、可脱球囊或电解可脱弹簧栓(GuglielmiDetachableCoil,GDC)经动脉或静脉途径栓塞瘘口。6例采用带毛弹簧栓,共54个,其中1例同时经眼静脉穿刺逆行栓塞海绵窦。7例采用球囊栓塞,1例因为瘘口小无法放置弹簧栓和球囊而采用GDC栓塞。结果:本组中13例CCF瘘口完全堵塞,其中4例同时堵塞颈内动脉,患者症状消失。1例已有6年病史的CCF颈内动脉参与大脑供血无法栓塞,经栓塞与海绵窦相通的颈外动脉后,又经眼静脉栓塞海绵窦致瘘口明显缩小。结论:经动脉内以球囊、弹簧栓或GDC栓塞是治疗CCF的有效方法,其中以球囊栓塞操作安全简便为首选材料。引流静脉粗大者逆行栓塞可以起补充作用。

Objective:To assess the value and method of endovascular embolization of carotico-cavernous fistula (CCF).Materials and Methods:Fourteen cases of CCF were treated by transarterial or transvenous embolization with metallic coil,balloon or GDC(Guglielmi Detachable Coil)according to the findings in DSA angiography.Fifty-four metallic coils were used in6cases,and in1case retrograde embolization of cavernous sinus were performed via ophthalmic vein.Seven cases were embolized with balloon and1case with GDC due to the small size of the fistula.Results:Thirteen cases of fistula were to-tally blocked and thus were cured.One fistula was retrogradely embolized via ophthalmic vein after embolization of external carotid artery and blood flow through fistula was greatly reduced.Internal carotid artery was sacrificed to block the fistula in4cases.Conclusion:Endovascular embolization is a valuable method to block carotico-cavernous fistula with coils,balloon or GDC.However,balloon is safer and easier.In rare case with big drainage veins retrograde transvenous embolization may be helpful.