摘要目的 探讨经动脉入路快速注射Onyx胶栓塞供血动脉纤细的海绵窦区硬脑膜动静脉瘘(DAVF)的临床疗效.方法 回顾性分析2010年12月至2016年12月苏州大学附属第一医院(12例)、海军军医大学附属长海医院(4例)、浙江大学医学院附属第二医院(4例)神经外科收治的共20例供血动脉纤细的海绵窦区DAVF患者的临床资料.患者均采用经动脉入路Onyx胶快速注射法进行栓塞治疗.结果 20例患者共进行22次血管内治疗,共经22支供血动脉栓塞,其中咽升动脉11次,脑膜中动脉7次,脑膜副动脉2次,颌内动脉2次.单次注胶时间为5 s至4 min,注胶量为0.4～1.5 ml.术中即刻完全栓塞8例,次全栓塞11例,部分栓塞1例(此例共栓塞3次).术后2例出现同侧颜面麻木,1例经3次动脉栓塞后出现同侧眼睑下垂、眼球活动障碍.随访时间为2～ 32个月,平均(9.5±2.7)个月.19例完全栓塞和次全栓塞的患者,其临床症状完全消失,其中18例球结膜充血、眼球突出的患者在术后2周内消失,1例球结膜水肿较重者于术后3周内水肿消失,复视和视力下降的症状均在术后1～3个月内好转,无复发病例.数字减影血管造影(DSA)随访12例,其中7例次全栓塞的患者DSA显示瘘口完全闭塞,无复发病例.结论 采用经动脉入路Onyx胶快速注射法可有效治疗供血动脉纤细的海绵窦区DAVF,其并发症较少,随访结果满意.

abstractsObjective To observe the efficacy of transarterial embolization of carvernous sinus dural arteriovenous fistulas (CSDAVFs) with slender feeding artery by rapid injection of Onyx.Methods From December 2010 to December 2016,a total of 20 patients with CSDAVFs with slender feeding artery were admitted to the Neurosurgery Department of the First Affiliated Hospital of Soochow University (12 cases),Changhai Hospital of the Second Military Medical University (4 cases) and the Second Affiliated Hospital of Medical College,Zhejiang University (4 cases).Those clinical data were analyzed retrospectively in this study.All underwent transarterial embolization with rapid injection of Onyx.Results Twenty-two interventional therapeutic procedures and embolization of feeding arteries were performed in all 20 patients,which involved ascending pharyngeal arteries in 11,middle meningeal arteries in 7,accessory meningeal arteries in 2 and internal maxillary arteries in 2.The mean time of Onyx injection was 5 sec-4 min and the volume of Onyx injected was 0.4 -1.5 ml.Postoperative immediate complete embolization was achieved in 8,near-complete embolization in 11 and partial embolization in 1 (with 3 repeats of procedures).Postoperatively,there were 2 cases of ipsilateral facial numbness and 1 case of ipsilateral eyelid ptosis and eye movement disorder occurring after 3 times of arterial embolization.The follow-up period was 2-32 months,with an average of 9.5 ± 2.7 months.In 19 patients with complete embolization and secondary embolization,the clinical symptoms disappeared completely.Among them,18 cases of conjunctival hyperemia and ocular protrusion disappeared within 2 weeks after operation,and 1 case of heavier conjunctival edema disappeared within 3 weeks after operation.The symptoms of diplopia and vision loss improved within 1 to 3 months after surgery,and there was no recurrence.Twelve patients were followed up by DSA,and 7 patients with complete embolization showed complete occlusion of the fistula and no recurrence.Conclusion Transarterial embolization with rapid injection of Onyx may effectively treat CSDAVFs with slenderfeeding artery with relatively little complications and satisfactory follow-up results.