海绵窦区自发性硬脑膜动静脉瘘血管内治疗研究

doi:10.3969/j.issn.1673-5765.2021.08.013

摘要/Abstract

摘要： 目的探讨自发性海绵窦区硬脑膜动静脉瘘（cavernous sinus dural arteriovenous fistula，CSDAVF）的临床特点及血管内介入栓塞治疗的疗效。方法回顾性分析2017年9月-2020年1月于首都医科大学附属北京同仁医院神经外科收治的经DSA 检查确诊为自发性CSDAVF并行介入栓塞治疗的连续住院患者临床资料。采用经静脉入路或动脉入路进行动静脉瘘栓塞术，根据情况采用单纯Onyx胶或联合弹簧圈进行栓塞，术后即刻及1年复查 DSA，比较经静脉入路和经动脉入路患者的栓塞程度，根据术后1年随访资料比较两组的1年临床预后情况。结果共纳入25例患者，年龄21～72岁。6例（24.0%）患者采用单纯Onyx胶栓塞，19例（76.0%）患者采用Onyx胶联合弹簧圈治疗。经静脉入路组17例，经动脉入路组8例。术后即刻DSA显示经静脉入路组12例（70.6%）完全栓塞，4例（23.5%）次全栓塞，1例（5.9%）部分栓塞；经动脉入路组7例（87.5%）完全栓塞，1例（12.5%）部分栓塞。1年随访DSA显示，经静脉入路组12例（70.6%）完全栓塞，4例（23.5%）次全栓塞，1例（5.9%）部分栓塞，经动脉入路组5例（62.5%）完全栓塞，2例（25.0%）次全栓塞，1例（12.5%）部分栓塞，两组术后即刻和1年栓塞率差异无统计学意义。术后1年经静脉入路组 11例（64.7%）临床治愈，5例（29.4%）好转，1例（5.9%）无效；经动脉入路组6例（75.0%）治愈，2例（25.0%）好转，两组1年临床预后差异也无统计学意义。结论对于CSDAVF患者，血管内治疗安全有效，经静脉入路和经动脉入路术后即刻和1年的栓塞率、 1年临床预后相似。

文章导读： 本研究回顾性分析连续25例CSDAVF患者的资料，结果显示介入治疗对动静脉瘘的栓塞效果较好，经静
脉入路和经动脉入路治疗方式的栓塞效果和患者1年临床预后效果相似。

关键词: 海绵窦区; 硬脑膜动静脉瘘; 临床特点; 介入栓塞治疗; 预后

Abstract: Objective To investigate the clinical characteristics of spontaneous cavernous sinus dural arteriovenous fistula (CSDAVF) and the efficacy of interventional embolization for CSDAVF. Methods From September 2017 to January 2020, the data of patients with CSDAVF diagnosed by DSA and treated with interventional embolization in Department of Neurosurgery of Beijing Tongren Hospital were retrospectively analyzed. After DSA evaluation, the patients were embolized through venous or arterial approach, with Onyx glue or combined with coils. The patients were followed up with DSA one year after the operation, and the degree of embolization and 1-year prognosis of the two methods were compared. Results A total of 25 cases were included, with a median age of 40 years old (range: 21-72 years old). 6 patients (24.0%) were embolized with Onyx glue alone, and 19 patients (76.0%) with Onyx glue combined with coil. 17 cases were treated through venous approach, and 8 cases

through arterial approach. DSA at the end of the procedure showed complete embolization in 12

cases (70.6%), subtotal embolization in 4 cases (23.5%) and partial embolization in 1 case (5.9%) in venous approach group; meanwhile, complete embolization in 7 cases (87.5%) and subtotal embolization in 1 case (12.5%) in arterial approach group. DSA at 1-year follow up showed complete embolization in 12 cases (70.6%), subtotal embolization in 4 cases (23.5%), and partial embolization in 1 case (5.9%) in venous approach group; and complete embolization in 5 cases (62.5%), subtotal embolization in 2 case (25.0%) and partial embolization in 1 case (12.5%) in arterial approach group. At 1- year follow up, in venous approach group, 11 cases (64.7%) were cured, 5 cases (29.4%) improved and 1 case (5.9%) showed no improvement; in arterial approach group, 6 cases (75.0%) were cured, and 2 cases (25.0%) improved. There was no statistical difference in the prognosis between the two groups. Conclusions Intravascular therapy for CSDAVF is safe and effective. It’s similar for transvenous approach or transarterial approach embolization in embolization rate at the end of and one year after the procedure.

Key words: Cavernous sinus; Dural arteriovenous fistula; Clinical characteristics;Interventional embolization; Prognosis

赵尚峰, 王卫, 梁熙虹, 张家亮, 孙思, 宋贵东, 康军. 海绵窦区自发性硬脑膜动静脉瘘血管内治疗研究[J]. 中国卒中杂志, 2021, 16(08): 828-833.

ZHAO Shang-Feng, WANG Wei, LIANG Xi-Hong, ZHANG Jia-Liang, SUN Si, SONG Gui-Dong, KANG Jun. Endovascular Therapy for Spontaneous Cavernous Sinus Dural Arteriovenous Fistula[J]. Chinese Journal of Stroke, 2021, 16(08): 828-833.

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