经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘

Transvenous embolization of cavernous dural arteriovenous fistulas

目的 探讨经静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘的效果、面临的问题及相应的处理。方法 经股静脉-岩下窦入路和经股静脉-面静脉-眼上静脉入路到达病变侧海绵窦,用GDC、EDC、游离弹簧圈和丝线等多种栓塞材料填塞海绵窦,同时闭塞瘘口。结果 应用两种静脉入路对13例病人的17侧海绵窦进行了栓塞治疗。10例治疗后即刻造影显示海绵窦和瘘口完全闭塞。3例虽将海绵窦闭塞,但仍残留岩下窦的引流(1例)和翼丛引流(2例)。栓塞术后最常见症状为头痛伴呕吐。1例伴有动眼神经麻痹的病例在栓塞治疗后其它眼部症状消失,但动眼神经功能仍未恢复。随访3个月到26个月未见复发。3例残留瘘口的病例均于术后3个月行脑血管造影复查:2例残留瘘口消失,1例仍有翼丛引流。其他病例未行脑血管造影复查。结论 经静脉途径栓塞治疗是海绵窦区硬脑膜动静脉瘘的有效方法,应作为首选治疗方法。

Objective To present the results of treatment of cavernous dural arteriovenous fistulas via the transvenous approach. Methods The involved cavernous sinuses were catheterized via femoral vein -inferior petrosal sinus approach or femoral vein -facial vein -superior opthalmic vein approach, and embolized with coils ( GDC, EDC or free coil) or coils and silk. Results 17 cavernous sinuses in 13 patients with cavernous dural arteriovenous fistulas were embolized. Immediate complete angiographic obliteration of the fistulas was achieved in 10 patients. Residual shunting was left in 3 patients, 2 with pteroid drainage and 1 with inferior petrosal sinus drainage. Headache and vomitting were the most common symptoms after embolization. The follow-up period ranged from 3 months to 26 months. Clinical cure was achieved in 10 of 13 patients. Angiography at the third month after emboli zation was performed in 3 patients with residual shunting, angiographic. cure in 2, residual pteriod drainage in 1. Follow-up angiography was not performed in other patients. Conclusion Transvenous catheterization and embolization of cavernous sinus was a safe and effective way to treat cavernous dural arteriovenous fistulas.