CAJ | 학술논문

目的探讨弹簧圈结合Onyx胶栓塞外伤性颈动脉海绵窦瘘(traumatic carotid cavernous fistula,T-CCF)的疗效及安全性.方法通过造影明确外伤性颈动脉海绵窦瘘瘘口的位置及回流特点后,经动脉入路将微导管自颈内动脉瘘口处送入病变侧海绵窦内,同时将保护球囊于颈内动脉瘘口处间断充盈以阻断瘘口血流保护颈内动脉,在海绵窦内近瘘口处填入少量弹簧圈后分次推注Onyx18胶,直至瘘口完全闭塞.结果 12例T-CCF患者共计13个瘘口(含1例双侧病变)在球囊辅助下采用弹簧圈结合Onyx胶进行栓塞治疗,其中11例单侧CCF术毕即刻造影显示瘘口完全消失;另1例双侧CCF分两次进行了栓塞.全部病例颈内动脉均保持通畅,术后原有的颅内杂音全部消失,眼部症状有不同程度恢复,术后未出现严重操作相关并发症,1例术后常规CT复查显示发生同侧侧裂区少量出血;随访3 ～ 20个月未见复发.结论弹簧圈结合Onyx胶栓塞颈内动脉海绵窦瘘是一种安全有效的治疗方法.
목적 탐토탄황권결합Onyx효전새외상성경동맥해면두루(traumatic carotid cavernous fistula,T-CCF)적료효급안전성.방법 통과조영명학외상성경동맥해면두루루구적위치급회류특점후,경동맥입로장미도관자경내동맥루구처송입병변측해면두내,동시장보호구낭우경내동맥루구처간단충영이조단루구혈류보호경내동맥,재해면두내근루구처전입소량탄황권후분차추주Onyx18효,직지루구완전폐새.결과 12례T-CCF환자공계13개루구(함1례쌍측병변)재구낭보조하채용탄황권결합Onyx효진행전새치료,기중11례단측CCF술필즉각조영현시루구완전소실;령1례쌍측CCF분량차진행료전새.전부병례경내동맥균보지통창,술후원유적로내잡음전부소실,안부증상유불동정도회복,술후미출현엄중조작상관병발증,1례술후상규CT복사현시발생동측측렬구소량출혈;수방3 ～ 20개월미견복발.결론 탄황권결합Onyx효전새경내동맥해면두루시일충안전유효적치료방법.
Objective To discuss the effectiveness and safety of endovascular treating method of coils combined with Onyx on traumatic carotid-cavernous fistula (T-CCF).Methods After confirming the location of traumatic carotid-cavernous fistula as well as draining characteristics,a micro-catheter was sent into the cavernous sinus of lesion side by transarterial approach with a balloon inflated to cover the fistula and protect the ICA.After several coils were deployed adjacent to the fistula,Onyx 18 was injected into cavernous sinus until the complete occlusion of fistula.Results Balloon-assisted embolization of coils combined with Onyx was adopted in totally 12 T-CCF cases of 13 CCF fistula (involving 1 case of bilateral lesion),among which 11 cases of unilateral lesion showed complete occlusion of fistula in immediate angiogram after treatment,and the other case of bilateral lesion underwent two sessions of embolization.All cases preserved the internal carotid artery lumen.The original symptoms of cranial bruit all disappeared and the ocular and orbital symptoms recovered to different levels.No severe complication related to operation occurred,though 1 case experienced a small amount of bleeding in the lateral fissure zone of the same side from routine CT scan after operation.Follow-up found no recurrence in 3 to 20 months.Conclusions Embolization with coils and Onyx is an effective and safe way on treatment of T-CCF.