Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin 53226, USA.
J Neurointerv Surg. 2011 Sep;3(3):255-62. doi: 10.1136/jnis.2010.003103. Epub 2011 Jan 10.
Carotid cavernous fistula (CCF) can be classified as either direct or indirect according to the arterial feeder source. The current standard treatment for CCF is endovascular embolization. In this case series, 21 CCF (direct and indirect) embolization procedures were treated with multimodal endovascular therapy to explore safety, technique and clinical efficacy.
The neurointerventional database was reviewed for all cases of CCF. Demographic information, indications for the procedure, presenting symptoms, endovascular therapy types, complications and procedure angiographic and clinical efficacy were collected.
21 CCF embolization procedures were performed using multimodal therapy on 15 patients (eight females and seven males) with a mean age of 56.4±22.4 years (15-90 years), with 60% traumatic CCF and 40% spontaneous CCF presenting mainly with typical visual symptoms. 10 patients were treated in one session, four patients underwent two sessions and one required three sessions of endovascular therapy. Complete fistula occlusion was achieved in 10/15 patients (73.3%) in one session and in 14/15 (93.3%) patients after two or more sessions. One patient's symptoms (case No 15) improved dramatically after the second session despite incomplete obliteration of the CCF. No periprocedural complications were reported. Long term follow-up showed one recurrence of the CCF with a mean follow-up time of 201±17.2 months (range 1-56 months). Patient No 6 was lost to follow-up.
Multimodal endovascular embolization of CCF appears to be safe with a high success rate of complete obliteration. This case series demonstrates complete occlusion in 73.3% of the patients after one session and in 93.3% after the second session.
根据动脉供血来源，海绵窦瘘（CCF）可分为直接型和间接型。CCF 的当前标准治疗方法是血管内栓塞。在本病例系列中，我们采用多模态血管内治疗方法治疗了 21 例 CCF（直接和间接）栓塞术，以探讨安全性、技术和临床疗效。
对所有 CCF 病例的神经介入数据库进行了回顾。收集了人口统计学信息、手术适应证、临床表现、血管内治疗类型、并发症以及手术血管造影和临床疗效。
15 例患者（8 例女性和 7 例男性）共进行了 21 例 CCF 栓塞术，平均年龄为 56.4±22.4 岁（15-90 岁），其中 60%为创伤性 CCF，40%为自发性 CCF，主要表现为典型的视觉症状。10 例患者一次完成治疗，4 例患者分两次进行，1 例患者需要进行三次血管内治疗。10/15 例（73.3%）患者在一次治疗中实现完全瘘闭合，14/15 例（93.3%）患者在两次或更多次治疗后实现完全瘘闭合。尽管 CCF 不完全闭塞，但 1 例患者（病例 15）的症状在第二次治疗后显著改善。无围手术期并发症发生。长期随访显示，1 例 CCF 复发，平均随访时间为 201±17.2 个月（范围 1-56 个月）。病例 6 失访。
多模态血管内 CCF 栓塞术安全有效，完全闭塞率高。本病例系列研究显示，一次治疗后 73.3%的患者和两次治疗后 93.3%的患者完全闭塞。
