Onyx embolization of carotid-cavernous fistulas
Onyx embolization of carotid-cavernous fistulas
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DOI：
10.3171/2009.6.jns09132
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发表时间：
2010-03-01
影响因子：
4.1
通讯作者：
Aziz-Sultan, Mohammad Ali
中科院分区：
文献类型：
--
作者：
Elhammady, Mohamed Samy;Wolfe, Stacey Quintero;Aziz-Sultan, Mohammad Ali
对象。作者进行了一项研究，以确定用乙烯乙烯醇共聚物（onyx）栓塞颈动脉-海绵窦瘘（CCFs）的安全性和有效性。他们前瞻性地收集了所有CCFs患者的数据，这些患者在他们的机构接受了3年的onyx基栓塞治疗。记录瘘管的类型、栓塞途径、粘稠度、线圈的额外使用、栓塞程度、手术并发症和临床随访。共有12例患者（5男7女，年龄24-88岁）接受了使用Onyx的栓塞治疗。巴罗A型1例，B型1例，C型3例，D型7例。经静脉栓塞8例，经动脉栓塞4例。除2例外，所有病例均使用了Onyx 34：直接a型瘘用Onyx 500栓塞，间接C型瘘用Onyx 18栓塞。7例行框架线圈辅助栓塞术。所有程序均在一次会议中完成。所有病例均可立即封堵瘘管。2个月时，100%的患者临床症状消失。3例出现神经系统并发症。1例患者出现完全性脑神经（CN） VII麻痹，至今未痊愈。2例患者出现一过性神经病变- 1例为Horner综合征和部分CN VI麻痹，1例为完全CN III和部分CN V麻痹。6例患者均获得影像学随访（平均16个月，范围4 - 35个月），所有患者病变完全消退。玛瑙是一种液体栓塞剂，对CCFs治疗有效，但并非没有危害。栓塞后海绵窦血栓形成和肿胀可导致短暂的压缩性颅神经病变。缟玛瑙固有的逐渐聚合特性允许海绵窦的铸造，但可能导致动脉侧枝的深度渗透，从而导致CN缺血/梗死。虽然尚未证实，二甲亚砜的血管毒性作用也可能在栓塞后CN缺陷中发挥作用。(DOI: 10.3171 / 2009.6.jns09132)
Object. The authors conducted a study to determine the safety and efficacy of embolization of carotid-cavernous fistulas (CCFs) with the ethylene vinyl alcohol copolymer, Onyx.Methods. They prospectively collected data in all patients with CCFs who underwent Onyx-based embolization at their institution over a 3-year period. The type of fistula, route of embolization, viscosity of Onyx, additional use of coils, extent of embolization, procedural complications, and clinical follow-up were recorded.Results. A total of 12 patients ( 5 men and 7 women who were age 24-88 years) underwent embolization in which Onyx was used. There were 1 Barrow Type A, 1 Type B, 3 Type C, and 7 Type D fistulas. Embolization was performed via a transvenous route in 8 cases and a transarterial route in 4 cases. Onyx 34 was used in all but 2 cases: a direct Type A fistula embolized with Onyx 500 and an indirect Type C fistula embolized with Onyx 18. Adjuvant embolization with framing coils was performed in 7 cases. All procedures were completed in a single session. Immediate fistula obliteration was achieved in all cases. Clinical resolution of presenting symptoms occurred in 100% of the patients by 2 months. Neurological complications occurred in 3 patients. One patient developed a complete cranial nerve (CN) VII palsy that has not resolved. Two patients developed transient neuropathies - 1 a Horner syndrome and partial CN VI palsy, and 1 a complete CN III and partial CN V palsy. Radiographic follow-up ( mean 16 months, range 4 - 35 months) was available in 6 patients with complete resolution of the lesion in all.Conclusions. Onyx is a liquid embolic agent that is effective in the treatment of CCFs but not without hazards. Postembolization cavernous sinus thrombosis and swelling may result in transient compressive cranial neuropathies. The inherent gradual polymerization properties of Onyx allow for casting of the cavernous sinus but may potentially result in deep penetration within arterial collaterals that can cause CN ischemia/infarction. Although not proven, the angiotoxic effects of dimethyl sulfoxide may also play a role in postembolization CN deficits. (DOI: 10.3171/2009.6.JNS09132)