血管内治疗作为外伤性颈内动脉海绵窦瘘的主要治疗方法：来自巴基斯坦的本地经验。

Endovascular approach as primary treatment for traumatic carotid cavernous fistula: local experience from Pakistan.

作者信息

Hamid Rana Shoaib, Shamim Muhammad Shahzad, Kazim Syed Faraz, Salam Basit

机构信息

Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.

出版信息

J Pak Med Assoc. 2011 Oct;61(10):989-93.

PMID:22356033

Abstract

OBJECTIVE

To evaluate the technical success, complications and outcome of endovascular management of post traumatic carotid cavernous fistula (CCF) in patients presenting at a tertiary care hospital in Karahci.

METHODS

Descriptive case series of 26 patients of post traumatic CCF treated by endovascular techniques was carried out at Radiology and Neurosurgery departments of Aga Khan University hospital between January 2010 to March 2010. Medical records and radiology reports were retrospectively reviewed from November 2000 to December 2009. The diagnosis was primarily clinical and was confirmed in all cases by CT or MRI. Endovascular procedures were performed under general anaesthesia through femoral artery or femoral vein approach. Detachable balloons pushable coils and/or glue was used for fistula closure. Follow up was done via medical records and on phone. Technical success and safety of the procedure were analyzed and outcome in terms of symptomatic improvement was recorded wherever available.

RESULTS

Out of a total of 26 patients; 20 were male and 6 were female, with age range of 14 to 62 years, mean age 31.4 +/- 12.6 years. Technical success rate of endovascular embolization was 92.3% (24 out of 26 patients). Procedure could not be performed in 2 patients. In 20 out of 24 patients (83.3%) single session of embolization was performed while 4 patients required 2 sessions due to recurrence. In one of these patients the detachable balloon deflated after 2 hours of deployment and another session of embolization was immediately carried out by deploying a larger sized balloon. Complication rate was 15.3% (n = 4) one patient had infarction which recovered completely in 6 months. There was no procedure related mortality. Five patients were lost to follow up. In rest of the 19 patients follow up ranged from 1 to 14 months (Mean 11.0 +/- 11.8 months) 8 out of 19 (42.1%) patients showed complete resolution of symptoms and 9 (47.3%) reported improvement.

CONCLUSION

Endovascular approach is a safe and useful option for treatment of traumatic carotid cavernous fistula.

摘要

目的

评估在卡拉奇一家三级医院就诊的创伤性颈内动脉海绵窦瘘（CCF）患者血管内治疗的技术成功率、并发症及治疗效果。

方法

2010年1月至2010年3月，在阿迦汗大学医院放射科和神经外科开展了一项描述性病例系列研究，纳入26例采用血管内技术治疗的创伤性CCF患者。回顾性分析2000年11月至2009年12月的病历和放射学报告。诊断主要依靠临床症状，所有病例均经CT或MRI确诊。血管内操作在全身麻醉下通过股动脉或股静脉途径进行。使用可脱性球囊、可推送弹簧圈和/或胶水封闭瘘口。通过病历和电话进行随访。分析该操作的技术成功率和安全性，并记录症状改善方面的治疗效果。

结果

26例患者中，男性20例，女性6例，年龄范围为14至62岁，平均年龄31.4±12.6岁。血管内栓塞的技术成功率为92.3%（26例患者中的24例）。2例患者无法进行该操作。24例患者中有20例（83.3%）进行了单次栓塞，4例患者因复发需要进行2次栓塞。其中1例患者的可脱性球囊在置入2小时后瘪掉，随即通过置入更大尺寸的球囊立即进行了另一轮栓塞。并发症发生率为15.3%（n = 4），1例患者发生梗死，6个月后完全康复。无手术相关死亡病例。5例患者失访。其余19例患者的随访时间为1至14个月（平均11.0±11.8个月），19例患者中有8例（42.1%）症状完全缓解，9例（47.3%）症状有所改善。