Yu Simon C H, Cheng Harold K M, Wong George K C, Chan Chi M, Cheung James Y L, Poon Wai S
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Neurosurgery. 2007 Jun;60(6):1032-7; discussion 1037-8. doi: 10.1227/01.NEU.0000255455.05355.31.
We report our experience gaining access to the cavernous sinus via transfacial catheterization of the superior ophthalmic vein through the angular or retromandibular vein. We evaluate the viability of this approach as a safe and convenient alternative pathway for transvenous embolization of the cavernous sinus.
This is a retrospective study of 98 patients with symptomatic dural carotid-cavernous fistulae from two major regional hospitals in Hong Kong. All 98 patients presented with one or more ocular symptoms. Seventy-four transvenous embolization procedures were performed on 71 patients. Transvenous access to the cavernous sinus was attempted through various pathways, one by one, until the cavernous sinus was successfully catheterized.
The overall technical success rate of transvenous embolization of dural carotid-cavernous fistulae in our study was 64 out of 74 patients (86.5%). Had we not used the technique of transfacial catheterization, the technical success rate would have been 53 out of 74 patients (71.6%). After adoption of the transfacial approach, the technical success rate of transvenous embolization became 64 out of 64 patients (100%). Residual symptoms occurred in eight patients. Two patients developed transient VIth cranial nerve palsy after transvenous embolization for 1 and 2 months, respectively. Otherwise, there were no complications.
Transfacial catheterization through the superior ophthalmic vein is a safe and effective approach and provides a convenient alternative pathway for transvenous embolization of dural carotid-cavernous fistulae when cannulation of the inferior petrosal sinus is not successful, thereby increasing the technical success rate.
我们报告经面经角静脉或下颌后静脉经皮穿刺眼上静脉进入海绵窦的经验。我们评估这种方法作为海绵窦经静脉栓塞安全便捷替代途径的可行性。
这是一项对香港两家主要地区医院98例有症状的硬脑膜颈动脉海绵窦瘘患者的回顾性研究。所有98例患者均有一个或多个眼部症状。对71例患者进行了74次经静脉栓塞手术。逐一尝试通过各种途径经静脉进入海绵窦，直到成功将导管插入海绵窦。
在我们的研究中，硬脑膜颈动脉海绵窦瘘经静脉栓塞的总体技术成功率为74例患者中的64例（86.5%）。如果我们没有使用经面导管插入技术，技术成功率将为74例患者中的53例（71.6%）。采用经面入路后，经静脉栓塞的技术成功率变为64例患者中的64例（100%）。8例患者出现残留症状。2例患者在经静脉栓塞后分别在1个月和2个月出现短暂性第六颅神经麻痹。除此之外，无并发症发生。
经眼上静脉经面导管插入术是一种安全有效的方法，当岩下窦插管不成功时，为硬脑膜颈动脉海绵窦瘘经静脉栓塞提供了一种便捷的替代途径，从而提高了技术成功率。
