Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Neurointerv Surg. 2013 May;5(3):e13. doi: 10.1136/neurintsurg-2011-010227. Epub 2012 Mar 2.
Direct surgical exposure and cannulation (DSEC) of the superior ophthalmic vein (SOV) can be used as an alternative approach for the endovascular treatment of cavernous sinus dural fistulas (CSDF) that fail conventional endovascular access. The aim of this study was to report the techniques, effectiveness and safety of DSEC of the SOV in these cases.
Between June 2007 and June 2011, nine CSDF in nine patients who presented with ocular signs and symptoms were embolized using DSEC of the SOV when the CSDF could not be treated via the transarterial or transfemoral venous route.
All nine patients were successfully treated by introduction of Onyx in conjunction with detachable coils through the catheterized SOV to the affected cavernous sinus. No exposure or catheterization of the SOV proved difficult. Symptoms and signs resolved completely in all patients after successful occlusion of the CSDF. There were no intraoperative complications. All patients underwent follow-up cerebral angiography at least 3 months after treatment, and none showed recurrence of the fistula.
DSEC of the SOV for embolization of a CSDF is a good alternative treatment when conventional venous routes are inaccessible. Surgical access to the SOV is direct and can be performed safely. The use of Onyx in conjunction with detachable coils is safe and effective for symptomatic CSDF.
直接手术暴露和插管（DSEC）上眼静脉（SOV）可作为治疗海绵窦硬脑膜瘘（CSDF）的替代方法，对于传统血管内入路失败的病例。本研究旨在报告 DSEC 治疗 CSDF 的技术、疗效和安全性。
2007 年 6 月至 2011 年 6 月，9 例 CSDF 患者出现眼部症状和体征，经动脉或股静脉途径治疗失败后，采用 DSEC 治疗 SOV。
所有 9 例患者均通过将 Onyx 与可解脱线圈经导管插入 SOV 至受影响的海绵窦，成功治疗。没有出现 SOV 暴露或插管困难的情况。成功闭塞 CSDF 后，所有患者的症状和体征完全缓解。术中无并发症。所有患者均在治疗后至少 3 个月进行了脑血管造影随访，均未见瘘复发。
当常规静脉入路无法到达时，DSEC 治疗 SOV 栓塞 CSDF 是一种较好的治疗选择。SOV 的手术入路直接且安全。Onyx 联合可解脱线圈的使用对有症状的 CSDF 是安全有效的。
