De Renzis Alioscia, Nappini Sergio, Consoli Arturo, Renieri Leonardo, Limbucci Nicola, Rosi Andrea, Vignoli Chiara, Pellicanò Giannantonio, Mangiafico Salvatore
Department of Radiology, Careggi University Hospital; Florence, Italy - E-mail:
Interv Neuroradiol. 2013 Sep;19(3):344-52. doi: 10.1177/159101991301900312. Epub 2013 Sep 26.
This study evaluated clinical and neuroradiological results in 13 consecutive patients with spontaneous and traumatic direct carotid cavernous fistulas treated at our center between January 2006 and September 2012. All patients were treated by coiling of the cavernous sinus. Coiling was always performed while a semi-compliant non-detachable balloon was temporarily inflated in the internal carotid artery. This technique (balloon-assisted coiling) permitted a clear visualization of the fistula, facilitated coil positioning and protected the patency of the artery. All patients' clinical data and radiological examinations were reviewed; nine patients underwent radiological and clinical follow-up, with a mean duration of 3.8 years (range: six months-six years). Overall results at discharge showed a complete occlusion of the fistula in seven patients (7/13, 54%) and a resolution of symptoms in eight patients (8/12, 67%). Radiological follow-up showed complete occlusion of the fistula in all patients (9/9, 100%) and clinical follow-up showed a resolution of symptoms in eight patients (8/9, 89%) and persistent symptoms in one (1/9, 11%). No procedure-related complications occurred. Balloon-assisted coiling of the cavernous sinus for the treatment of direct carotid cavernous fistulas proved an effective and safe technique, both in angiographic and clinical terms, and may be considered a technical improvement.
本研究评估了2006年1月至2012年9月期间在我们中心接受治疗的13例自发性和创伤性直接颈内动脉海绵窦瘘患者的临床和神经放射学结果。所有患者均采用海绵窦内栓塞治疗。栓塞时，始终在颈内动脉内临时充盈半顺应性不可脱卸球囊。这种技术（球囊辅助栓塞）能清晰显示瘘口，便于弹簧圈定位，并保护动脉通畅。回顾了所有患者的临床资料和影像学检查；9例患者接受了影像学和临床随访，平均随访时间为3.8年（范围：6个月至6年）。出院时的总体结果显示，7例患者（7/13，54%）瘘口完全闭塞，8例患者（8/12，67%）症状缓解。影像学随访显示所有患者（9/9，100%）瘘口完全闭塞，临床随访显示8例患者（8/9，89%）症状缓解，1例患者（1/9，11%）仍有持续症状。未发生与手术相关的并发症。海绵窦球囊辅助栓塞治疗直接颈内动脉海绵窦瘘在血管造影和临床方面均证明是一种有效且安全的技术，可被视为一项技术改进。
