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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2020, Vol. 10 ›› Issue (02) : 94 -98. doi: 10.3877/cma.j.issn.2095-123X.2020.02.007

所属专题： 文献；

颅内动脉瘤

球囊辅助弹簧圈联合Onxy胶治疗颈内动脉海绵窦瘘的疗效分析
刘泠1, 吴娅秋1, 王奇1, 谭海斌1, 程美雄1, 张天1,†()   
  1. 1. 610072　成都，四川省医学科学院·四川省人民医院神经外科
  • 收稿日期:2020-08-02 出版日期:2020-04-15
  • 通信作者: 张天

Efficacy of balloon-assisted sinus coiling plus Onxy embolization technique in the treatment of carotid cavernous fistula

Ling Liu1, Yaqiu Wu1, Qi Wang1, Haibin Tan1, Meixiong Cheng1, Tian Zhang1,†()   

  1. 1. Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, China
  • Received:2020-08-02 Published:2020-04-15
  • Corresponding author: Tian Zhang
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引用本文：

刘泠, 吴娅秋, 王奇, 谭海斌, 程美雄, 张天. 球囊辅助弹簧圈联合Onxy胶治疗颈内动脉海绵窦瘘的疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(02): 94-98.

Ling Liu, Yaqiu Wu, Qi Wang, Haibin Tan, Meixiong Cheng, Tian Zhang. Efficacy of balloon-assisted sinus coiling plus Onxy embolization technique in the treatment of carotid cavernous fistula[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(02): 94-98.

目的

探讨球囊辅助弹簧圈联合Onxy胶治疗颈内动脉海绵窦瘘（CCF）的安全性及有效性。

方法

四川省医学科学院·四川省人民医院神经外科自2018年1月至2020年6月共收治CCF患者19例，均采用球囊辅助弹簧圈联合Onxy胶介入治疗。其中11例岩下窦开放者行经岩下窦静脉途径栓塞治疗，另8例行经颈内动脉瘘口动脉途径栓塞。

结果

19例患者栓塞后即刻造影显示海绵窦瘘口完全封闭。术后常规复查头颅CT，未见栓塞剂异位栓塞表现，无新发神经功能障碍表现。所有患者于术后即刻眼静脉症状及颅鸣耳鸣症状均有明显缓解，1~2周内逐步消失。而存在颅神经麻痹症状患者，眼外肌麻痹症状缓解则相对缓慢。

结论

通过三维成像后处理剪辑技术，可精准判断瘘口位置；无论经动脉或静脉入路，封堵球囊可精准封闭瘘口，在栓塞过程中使弹簧圈及Onxy胶尽可能接近瘘口附近，从而减少费用，同时提高CCF治疗的安全性及有效性，减少并发症。

关键词: 颈内动脉海绵窦瘘, 栓塞, 静脉入路, 动脉入路
Objective

To discuss the safety and efficacy of balloon-assisted sinus coiling plus Onxy embolization technique in the treatment of carotid cavernous fistula (CCF).

Methods

Nineteen cases of CCF admitted into the Department of Neurosurgery of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from January 2018 to June 2020, are retrospectively studied. Balloon-assisted sinus coiling plus Onxy embolization technique was conducted in all cases. Among them, 11 cases with open inferior petrosal sinus were treated with embolization via inferior petrosal sinus vein, and 8 cases were treated with transcatheter arterial embolization via internal carotid artery fistula.

Results

Immediate obliteration of the fistula was achieved in all cases, without additional neurological dysfunction. Symptoms resulting from ophthalmic vein hypertension relieved evidently immediately after the surgery and gradually disappeared within 1-2 weeks. The symptoms of extraocular muscle paralysis were relieved relatively slowly.

Conclusion

Through imaging editing technique after 3D-image reconstruction, the location of fistula can be accurately determined, making the coil and Onxy glue as close to the fistula as possible, so as to reduce the cost, improve the safety and efficacy of CCF treatment.

Key words: Carotid cavernous fistula, Embolization, Transvenous pathway, Transarterial pathway
图1 典型病例1经岩下窦静脉途径CCF介入栓塞
图2 典型病例2经颈内动脉瘘口动脉途径CCF介入栓塞
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