Luo Bin, Zhang Xin, Duan Chuan-Zhi, He Xu-Ying, Li Xi-Feng, Karuna Tamrakar, Gu Da-Qun, Long Xiao-Ao, Li Tie-Lin, Zhang Shi-Zhong, Ke Yi-Quan, Jiang Xiao-Dan
Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, P R China.
Br J Neurosurg. 2013 Apr;27(2):187-93. doi: 10.3109/02688697.2012.722238. Epub 2012 Sep 17.
The purpose of this study was to evaluate the safety and efficacy of transorbital puncture for the retreatment of previously embolized cavernous sinus dural arteriovenous fistulas (DAVFs) via a superior ophthalmic vein (SOV) approach.
During a 12-year period, 9 consecutive patients with previously embolized cavernous sinus DAVFs underwent retreatment via the transorbital SOV approach.
All of the nine cases of previously embolized cavernous sinus DAVFs were successfully embolized. Clinical follow-ups were conducted in all nine cases at the duration of 17-141 months (61.22 ± 39.13 months). No recanalization occurred during the follow-up period. A subtle ptosis appeared in two patients and disappeared in one of the two cases after a 4-year follow-up. One patient suffered from paroxysmal positional vertigo and bruit for nearly 2 years after the treatment, but the follow-up angiography demonstrated no recurrence. One patient had persistent visual impairment caused by the initial venous stasis retinopathy. One patient with a history of a procedure-related transient decrease in visual acuity had it return to the normal level. The remaining four cases had clear improvement in the ocular symptoms and became completely asymptomatic during the follow-up period. No patient worsened or developed new symptoms.
The approach of surgical cannulation of the SOV for the retreatment of previously embolized cavernous sinus DAVFs was proved feasible and efficient, especially when the transarterial and transfemoral venous approaches were inaccessible. However, if the SOV is not dilated enough or is located deeply in the orbit, transorbital venous puncture access may not be possible.
本研究旨在评估经眶穿刺通过眼上静脉（SOV）途径对先前已栓塞的海绵窦硬脑膜动静脉瘘（DAVF）进行再治疗的安全性和有效性。
在12年期间，9例先前已栓塞的海绵窦DAVF患者通过经眶SOV途径接受了再治疗。
9例先前已栓塞的海绵窦DAVF均成功栓塞。对所有9例患者进行了17 - 141个月（61.22±39.13个月）的临床随访。随访期间未发生再通。2例患者出现轻微上睑下垂，其中1例在4年随访后消失。1例患者在治疗后近2年出现阵发性位置性眩晕和杂音，但随访血管造影显示无复发。1例患者因最初的静脉淤滞性视网膜病变导致持续性视力损害。1例有手术相关短暂视力下降病史的患者视力恢复正常。其余4例患者眼部症状明显改善，随访期间完全无症状。无患者病情恶化或出现新症状。
经眶穿刺SOV途径对先前已栓塞的海绵窦DAVF进行再治疗被证明是可行且有效的，特别是在经动脉和经股静脉途径不可行时。然而，如果SOV扩张不足或位于眼眶深部，则可能无法进行经眶静脉穿刺。
