Transvenous embolization treatment of refractory traumatic carotid-cavernous fistula
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摘要:
目的评价经静脉入路栓塞治疗难治性外伤性颈动脉海绵窦瘘（TCCF）的疗效，强调保留颈内动脉通畅的重要性。 方法回顾性分析近3年经静脉入路弹簧圈联合Onyx胶栓塞的8例外伤性TCCF，所有病例经动脉入路球囊闭塞瘘口失败，后接受经静脉入路栓塞瘘口，术后3~18个月脑血管造影和临床随访评价其疗效。 结果5例单纯经静脉入路栓塞完全闭塞瘘口，2例经动脉入路植入可脱球囊联合经静脉入路栓塞完全闭塞瘘口，治愈率为87.5%；1例经静脉入路栓塞后遗留海绵窦内假性动脉瘤，3个月后复查动脉瘤消失；术中均未出现远端脑栓塞、脑出血症状，2例患者新发外展神经麻痹，术后2~6个月症状逐步改善并最终消失；术后3~18个月随访造影7例瘘口完全闭塞颈内动脉通畅，1例瘘口消失，同侧颈内动脉闭塞；同时所有病例眼部症状及颅内杂音均消失。 结论经静脉入路栓塞治疗外伤性颈动脉海绵窦瘘安全有效，为保留颈内动脉，可作为难治性TCCF的一种重要的治疗方法。 -
关键词:
- 外伤性颈动脉海绵窦瘘 /
- 血管内治疗 /
- 岩下窦 /
- Onyx胶
Abstract:ObjectiveTo evaluate the effect of transvenous embolization treatment of refractory traumatic carotid-cavernous fistula (TCCF), and emphasize the importance of keeping carotid artery unobstuction. MethodsWe retrospectively analyzed 8 TCCF treated by transvenous coil combined Onyx glue embolization approach in the past three years. all cases treated by transarterial balloon blocking the fistula approach failed, then received transvenous embolization of the fistula. After 3 -18 months, we evaluated the efficiacy through cerebral angiography and clinical follow-up. Results5 cases treated by simple transvenous embolization completely blocked the fistula. 2 cases treated by transarterial detachable balloon combined with transvenous embolization completely blocked the fistula, the cure rate was 87.5%. 1 case treated by transvenous embolization appears the cavernous pseudoaneurysm, the aneurysm disappeared after three months. None of the patients reported distal cerebral embolism and cerebral bleeding during operation, but 2 cases first appear abducens nerve palsy, gradually improved and eventually disappeared after 2-6 months. After follow-up 3-18 months, fistula occlusion of 7cases completely blocked and carotid artery unobstructed. Fistula of 1case disappeared, the ipsilateral carotid artery obstructed. Eye symptoms and intracranial murmur of all cases disappeared. ConclusionTransvenous embolization treatment of traumatic carotid-cavernous fistula is safe and effective. To preserve the internal carotid artery, it can be used as an important method for treating refractory TCCF -
Key words:
- traumatic carotid-cavernous fistula /
- edovascular treatment /
- ptrosal sinus /
- onyx glue
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