Department of Medical Imaging, The Prince of Wales Hospital, Randwick, New South Wales, Australia.
J Neurointerv Surg. 2014 Jun;6(5):400-3. doi: 10.1136/neurintsurg-2013-010768. Epub 2013 Jun 8.
Dural arteriovenous fistulas are vascular malformations with variable clinical symptoms that range in severity from completely asymptomatic to seizures, dementia, loss of vision and intracranial hemorrhage. Historically, surgical obliteration was the treatment of choice but, more recently, endovascular embolization has become the first-line treatment. The liquid embolic agent Onyx (ethyl vinyl copolymer) has become the agent of choice, but problems with reflux around the delivery microcatheter and inadvertent venous penetration have arisen.
We present six cases in which the double-lumen balloon microcatheter was used to transarterially embolize dural arteriovenous fistulas via injection of Onyx through the wire lumen. Depending on the individual pathology a venous balloon was also used in some cases. The advantages and disadvantages of the use of these devices are discussed.
We consider that the use of the double-lumen balloon technique for fistula embolization has the potential for reducing overall procedural times, procedural failures and catheter retention in certain situations. In such cases we would advocate this as a first-line technique. When lower profile, more navigable balloon catheters become available, this may become the standard of care.
硬脑膜动静脉瘘是一种血管畸形，其临床症状轻重不一，从完全无症状到癫痫、痴呆、视力丧失和颅内出血不等。历史上，手术闭塞是首选治疗方法，但最近，血管内栓塞已成为一线治疗方法。液体栓塞剂 Onyx（乙烯-醋酸乙烯共聚物）已成为首选的治疗药物，但在输送微导管周围出现反流和静脉意外穿透的问题。
我们介绍了 6 例通过经动脉注射 Onyx 通过导丝腔栓塞硬脑膜动静脉瘘的病例，使用了双腔球囊微导管。根据个体病理情况，在某些情况下也使用了静脉球囊。讨论了使用这些设备的优缺点。
我们认为，在某些情况下，使用双腔球囊技术进行瘘栓塞有可能减少整体手术时间、手术失败和导管滞留。在这种情况下，我们会将其作为一线技术。当更具优势的、更具可操作性的球囊导管出现时，这种方法可能成为标准的治疗方法。
