Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience
Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience
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DOI：
10.1016/j.jstrokecerebrovasdis.2015.08.016
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发表时间：
2015-12-01
影响因子：
2.5
通讯作者：
Ibrahim, Tamer
中科院分区：
文献类型：
--
作者：
Hassan, Tamer;Rashad, Sherif;Ibrahim, Tamer
背景：海绵窦瘘分为外伤性和自发性。外伤性颈动脉海绵窦瘘(CCF)通常是直接的颈内动脉(ICA)高流量瘘，而自发性CCF通常是硬脑膜低流量瘘，通常没有直接的颈动脉-海绵窦瘘症状严重。方法：34例患者分为2组：A组26例为颈动脉海绵窦瘘，B组为8例硬脑膜海绵窦瘘。所有患者均有眼部表现。蛛网膜下腔出血1例。直接瘘19例，硬膜瘘1例，均单独使用弹簧圈。对7例直接瘘和2例硬脑膜瘘患者分别使用Covidien，Mansfield，USA，Onyx弹簧圈和ONYX。5例硬脑膜瘘患者仅用Onyx治疗，未发现直接瘘管。2例直接瘘采用覆膜支架加弹簧圈。结果：两组患者临床症状、体征均完全恢复。仅有1例(3%)发生与手术相关的并发症，其中1例患者因颈外动脉-ICA吻合术中的Onyx返流而发生栓子事件和三叉神经感觉障碍。结论：弹簧圈是治疗直接高流量瘘管的较好的固体栓塞剂，而Onyx在治疗硬脑膜低流量CCF时更有价值。玛瑙缩短了手术时间，降低了手术成本。经动脉或静脉途径在CS本身内注射玛瑙可能比在供应CS的硬膜动脉内注射Onyx更安全。然而，需要更多的案例来确定这一点。(C)2015年全国中风协会。爱思唯尔公司出版，版权所有。
Background: Cavernous sinus (CS) fistulas are classified into traumatic and spontaneous. Traumatic carotid-cavernous fistulas (CCFs) are usually direct internal carotid artery (ICA) high-flow fistulas; whereas spontaneous CCFs are usually dural, low-flow fistulas and generally possess less severe symptoms than direct carotid-cavernous fistulas. Methods: This study involved 34 patients who were classified into 2 groups: Group A included 26 patients with direct carotid-cavernous fistula; and Group B included 8 patients with indirect dural cavernous fistula. All patients had ocular manifestations. One patient had subarachnoid hemorrhage. Coils were used alone in 19 cases of direct fistula and in 1 case of dural fistulas. Coils and Onyx (Covidien, Mansfield, MA, USA) were used in 7 cases of direct fistula and in 2 cases of dural fistulas. Onyx alone was used to treat 5 cases with dural fistulas but none of the cases with direct fistulas. Covered stents and coils were used in 2 cases of direct fistulas. Results: All patients in both groups showed full recovery of their clinical signs and symptoms. Only 1 procedure-related complication was observed (3%) in which a patient had an embolic event and trigeminal dysesthesia as a result of Onyx reflux through external carotid artery-ICA anastomosis. Conclusion: Coils are superior solid embolic agents used for the treatment of direct high-flow fistulas, while Onyx is more valuable in dural low-flow CCF. Onyx shortens the procedure time and decreases procedure cost. Onyx injection inside the CS proper through the transarterial or transvenous route may be safer than Onyx injected inside dural arteries supplying the CS. However, more cases are needed to determine this. (C) 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.