CAJ | 학술논문

目的总结微弹簧圈、Onyx胶以及覆膜支架治疗颈动脉海绵窦瘘(carotid cavernous fistula,CCT)的初步体会.方法 25例CCF患者,其中外伤性22例,自发性3例;14例瘘口位于右侧颈内动脉(internal carotid artery,ICA)海绵窦段,11例位于左侧ICA海绵窦段.按Barrow分型:A型22例,C型2例,D型1例.18例单纯应用可脱弹簧圈治疗,1例应用可脱弹簧圈结合Onyx栓塞治疗,2例单纯应用Onyx栓塞治疗,4例应用覆膜支架治疗.结果所有病例术后颅内杂音立即消失,术后造影见瘘口完全闭塞,1～20 d后临床症状消失,无死亡以及手术相关性并发症.弹簧圈治疗患者ICA通畅占12/18,4例带膜支架治疗患者ICA均通畅.2例Onyx治疗患者ICA通畅,1例可脱弹簧圈结合Onyx治疗患者ICA通畅.1例经弹簧圈治疗的外伤性CCF 1个月后复发,经再次弹簧圈治愈.其余患者随访6～24个月未见临床症状复发,6例术后获得脑血管造影随访,CCF均未见复发.结论弹簧罔、Onyx 和覆膜支架血管内治疗是一种安全和有用的CCF治疗方法.
목적 총결미탄황권、Onyx효이급복막지가치료경동맥해면두루(carotid cavernous fistula,CCT)적초보체회.방법 25례CCF환자,기중외상성22례,자발성3례;14례루구위우우측경내동맥(internal carotid artery,ICA)해면두단,11례위우좌측ICA해면두단.안Barrow분형:A형22례,C형2례,D형1례.18례단순응용가탈탄황권치료,1례응용가탈탄황권결합Onyx전새치료,2례단순응용Onyx전새치료,4례응용복막지가치료.결과 소유병례술후로내잡음립즉소실,술후조영견루구완전폐새,1～20 d후림상증상소실,무사망이급수술상관성병발증.탄황권치료환자ICA통창점12/18,4례대막지가치료환자ICA균통창.2례Onyx치료환자ICA통창,1례가탈탄황권결합Onyx치료환자ICA통창.1례경탄황권치료적외상성CCF 1개월후복발,경재차탄황권치유.기여환자수방6～24개월미견림상증상복발,6례술후획득뇌혈관조영수방,CCF균미견복발.결론 탄황망、Onyx 화복막지가혈관내치료시일충안전화유용적CCF치료방법.
Objective To summarize the preliminary experience of coils, Onyx and covered stents for the treatment of carotid-cavernous sinus fistula (CCF). Methods Of the 25patients with CCF, 22 were traumatic CCF, and 3 were spontaneous CCF; the fistula orifices of 14 patients were located in the cavernous segment of right internal carotid artery (ICA), and 11were located in the cavernous segment of left ICA. According to the Barrow classification,Types A, C, and D were 22,2, and 1, respectively. Eighteen patients were treated with Guglielmi detachable coils alone, 1 was treated with Guglielmi detachable coils and Onyx, 2 were treated with Onyx alone, and 4 were treated with covered stents. Results Intracranial bruit disappeared immediately in all patients after the procedures. Postoperative angiography showed complete occlusion of the fistula orifices, the symptoms disappeared after 1 to 20 days, and there were no death and procedure-related complications. The recanalized ICAs were patent in patients (12/18) treated with coils, and the ICAs were patent in 4 patients treated with the covered stents.The ICAs were patent in 2 patients treated with Onyx, the ICA was patent in 1 patent treated with detachable coils and Onyx. One patient with traumatic CCF treated with coils had clinical recurrence, and was cured after re-embolization with coils. The remaining patients were followed-up for 6 to 24 months, and no recurrence of clinical symptoms was found. The followup cerebral angiography of 6 patients was obtained, and no CCF recurrence was observed.Conclusion Endovascular treatment with Guglielmi detachable coils, Onyx, and covered stents is a safe and useful method for closing CCFs.