经动脉入路血管内治疗142例创伤性颈内动脉海绵窦瘘临床分析

摘要

目的 验证经动脉入路血管内治疗对创伤性颈内动脉海绵瘘(CCF)的治疗效果.方法 142例经全脑血管造影确诊为颈内动脉海绵窦瘘,行常规可脱球囊栓塞术,其中7例行球囊栓塞失败,改为全麻下行Jostent覆膜支架成形术.结果 135例患者局麻下成功行可脱球囊栓塞术,7例行球囊栓塞失败后于全麻下成功行Jostent覆膜支架成形术.分别有2例和1例患者于术后2～46小时出现动眼神经麻痹和外展神经麻痹,其中2例于7天和12天完全缓解;4例球囊栓塞患者术后3小时～2周复发,所有覆膜支架治疗患者无复发.结论 应用可脱球囊栓塞仍是治疗颈内动脉海绵窦瘘的首选治疗方法,但对颈动脉破口太小、海绵窦太小、瘘口过大、瘘口附近存在锐利骨折片等不适合可脱球囊治疗的,在确认脑底动脉环代偿良好的情况下可以闭塞患侧颈内动脉治疗;对于颈内动脉虹吸段有良好解剖的患者可以使用Jostent覆膜支架治疗.%Objective To evaluate the effects of endovascular therapy by artery approach on direct carotid cavernous fistula. Methods All patients with carotid -cavernous fistula(CCF) were diagnosed by cerebral angiog raphy. Totally 142 cases were treated with embolization of traumatic carotid cavernous fistula with detachable bal loons. Patients who failed balloon therapy were performed with Jostent graft stent angioplasty . Results Totally 135 cases were performed with detachable balloon treatment successfully and 7 were successfully performed with Jostent graft stent angioplasty after failing detachable balloon therapy . Two cases were found oculomotor palsy and one case was found abducens nerve palsy within 2-46 hours after operation, however, two of the three patients were found complete remission within 7-12 days following operation. Four cases with detachable balloon therapy recurred within 3 hours to 2 weeks following operation , but no recurrence was found in patients treated with Jostent graft stent . Conclusion Transarterial therapy is an effective method for treating carotid -cavernous fistula. But it is advised to perform detachable balloon treatment after checking the carotid -cavernous fistula. Blocking of the corresponding ca rotid artery could be employed after confirming that there is good compensation of cerebral circulation through the circle of Willis. Jostent graft stent angioplasty can only be applied to those patients who have suitable anatomy con dition at carotid siphon.