目的 探讨在Scepter球囊保护下应用弹簧圈结合Onyx胶栓塞治疗创伤性颈动脉海绵窦瘘(TCCF)的安全性及治疗效果. 方法 采用回顾性病例系列研究分析2012年2月—2017年2月收治的24例球囊保护下弹簧圈结合Onyx胶栓塞治疗的TCCF患者临床资料,其中男20例,女4例;年龄21 ～ 65岁[(42.6±6.8)岁].格拉斯哥昏迷评分(GCS)15分.均为单侧病变.其中右侧13例,左侧11例.伴发颅内杂音23例,搏动性突眼伴球结膜充血水肿22例,眼球运动障碍19例,视力减退9例.术中通过微导管造影明确TCCF瘘口的位置及回流特点.将保护球囊置于颈内动脉瘘口处,再沿微导管在海绵窦内近瘘口处填人少量弹簧圈后分次推注Onyx胶,直至瘘口闭塞.观察患者术前及术后2周颅内杂音、搏动性突眼、视力障碍、眼球运动障碍改善情况,术后复查数学减影血管造影(DSA)了解颈内动脉通畅情况及复发情况. 结果 术后2周,24例TCCF患者原有颅内杂音、搏动性突眼、球结膜水肿症状均消失,19例眼球活动障碍患者中2例改善不明显,9例视力障碍患者中2例改善不明显,与术前比较差异有统计学意义(P＜0.05).1例Onyx胶与保护球囊粘连,将球囊连同导引导管送至颈外动脉后撤出球囊,术后患者无并发症.随访6 ～12个月,临床症状未见复发,无手术相关并发症,DSA示瘘口均完全闭塞,且颈内动脉均保持通畅. 结论 Scepter球囊保护下弹簧圈结合Onyx胶栓塞治疗TCCF可闭塞瘘口,消除眼部症状,维持颈内动脉通畅,是一种安全有效的方法.%Objective To evaluate the efficacy and safety of embolization with Scepter balloonassisted coils and Onyx glue in treatment of traumatic carotid cavernous fistula (TCCF).Methods A retrospective case series study was conducted on the clinical data of 24 patients with TCCF managed with embolization with Scepter balloon-assisted coils and Onyx glue from February 2012 to February 2017.There were 20 males and 4 females,aged 21-65 years [(42.6 ± 6.8) years],with Glasgow coma scale (GCS) of 15 points.All patients were with unilateral lesions,with 13 on the right and 11 on the left.Among TCCF patients,23 patients were with cranial bruit,22 with pulsating exophthalmos and bulbar conjunctiva congestion edema,19 with orbital symptoms,and 9 with visual impairment.A micro-catheter was sent into the cavernous sinus of lesion side,and the location of traumatic carotid cavernous fistula and draining characteristics were identified by micro catheter contrast.With a balloon inflated to cover the fistula and protect the interual carotid artery,Onyx was injected into the cavernous sinus after several coils were deployed adjacent to the fistula until the complete occlusion of fistula.Cranial bruit,pulsating exophthalmos,visual impairment,and orbital symptoms before operation and 2 weeks after operation were observed.Six months after operation,digital subtraction angiography (DSA) was reviewed to evaluate the carotid artery patency and TCCF recurrence.Results The cranial bruit,pulsating exophthalmos,and bulbar conjunctiva congestion edema in all TCCF patients disappeared 2 weeks after operation.No obvious improvement was seen in 2 out of 9 patients with visual impairments and 2 out of 19 patients with orbital symptoms,but there was significant improvement after operation (P ＜ 0.05).Onyx glue adhering to the surface of the protective balloon occurred in one patient.The balloon and catheter were delivered to the external carotid artery and then removed,with no complication seen.Follow-up found no recurrence or operative complications in 6-12 months.Complete occlusion of fistula was seen in all patients,and the internal carotid artery showed good patency.Conclusion Embolization with Scepter balloon-assisted coils and Onyx glue can occlude fistula,eliminate ocular symptoms,and maintain internal carotid artery patency and hence is an effective and safe treatment option for TCCF.
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