Klisch Joachim, Huppertz Hans Juergen, Spetzger Uwe, Hetzel Andreas, Seeger Wolfgang, Schumacher Martin
Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
Neurosurgery. 2003 Oct;53(4):836-56; discussion 856-7. doi: 10.1227/01.neu.0000083551.26295.ab.
To evaluate findings for patients with carotid cavernous fistulae or dural arteriovenous fistulae (AVFs) who underwent transvenous embolization via different transvenous approaches.
Retrospective analysis of data for 31 patients (age range, 17-81 yr; mean age, 59.3 yr) with carotid cavernous fistulae (n = 6) or dural AVFs (cavernous sinus [CS], n = 11; transverse/sigmoid sinus, n = 14) was performed. The AVFs were treated with coils via different transvenous approaches, in 56 procedures. Doppler ultrasonography and time-resolved, two-dimensional, magnetic resonance projection angiography were performed to confirm the treatment. The mean clinical follow-up period was 32.5 months.
A total of 34 transvenous procedures were performed for 17 AVFs of the CS. Eleven patients with AVFs of the CS (63%) were cured with respect to clinical symptoms, and six patients experienced improvement (37%). The approach via the internal jugular vein and inferior petrosal sinus (n = 15) was possible in 60% of cases, with complete occlusion of the fistula in 78% of cases. With the approach via the facial vein (n = 8), there was a 50% success rate. The superior ophthalmic vein approach (n = 5) was associated with a high rate of technical success (100%), with a rate of complete fistula occlusion of 80%. We encountered complications, with transient morbidity, in four cases (23.5%). For 14 dural AVFs of the transverse/sigmoid sinus, 22 transvenous procedures were performed; 12 patients were cured (85.7%) and 2 experienced improvement (14.3%). The technical success rate was 86%, with complete occlusion in 42% of cases. Minor complications occurred in six cases (42.9%) but did not lead to permanent morbidity.
Transvenous treatment of CS and transverse/sigmoid sinus AVFs can be effective if all transvenous approaches, including combined surgical/endovascular approaches, are considered.
评估经不同静脉入路行经静脉栓塞术的海绵窦瘘或硬脑膜动静脉瘘（AVF）患者的治疗结果。
对31例患者（年龄范围17 - 81岁，平均年龄59.3岁）的数据进行回顾性分析，其中海绵窦瘘6例，硬脑膜AVF（海绵窦[CS] 11例，横窦/乙状窦14例）。通过不同静脉入路对AVF进行了56次弹簧圈栓塞治疗。采用多普勒超声和时间分辨二维磁共振血管造影来确认治疗效果。平均临床随访期为32.5个月。
对CS的17个AVF共进行了34次经静脉手术。11例CS的AVF患者（63%）临床症状治愈，6例患者症状改善（37%）。经颈内静脉和岩下窦入路（n = 15）在60%的病例中可行，78%的病例瘘口完全闭塞。经面静脉入路（n = 8）成功率为50%。经眼上静脉入路（n = 5）技术成功率高（100%），瘘口完全闭塞率为80%。4例（23.5%）出现并发症及短暂性发病。对14个横窦/乙状窦硬脑膜AVF进行了22次经静脉手术；12例患者治愈（85.7%），2例患者症状改善（14.3%）。技术成功率为86%，42%的病例瘘口完全闭塞。6例（42.9%）出现轻微并发症，但未导致永久性发病。
如果考虑所有经静脉入路，包括联合手术/血管内入路，经静脉治疗CS和横窦/乙状窦AVF可能有效。
