Halbach V V, Higashida R T, Hieshima G B, Hardin C W, Pribram H
Department of Radiology, University of California, San Francisco, CA 94143.
AJNR Am J Neuroradiol. 1989 Mar-Apr;10(2):377-83.
Because of the risks associated with arterial embolization of cavernous dural fistulas, we have sought an alternative method to promote fistula closure. Thirteen patients underwent transvenous embolization as a treatment for symptomatic cavernous dural fistulas. All procedures were performed from a femoral vein access through the inferior petrosal sinus or basilar plexus. In five patients the inferior petrosal sinus was not angiographically demonstrable; however, embolization was still possible through this route in two patients. The embolic agents used were detachable balloons in one patient, coils alone in five, coils and liquid adhesives in four, coils plus silk sutures in one, silk sutures alone in one, and liquid adhesives alone in one. Nine patients had follow-up angiograms, which showed complete obliteration of the fistulas and complete resolution of related symptoms. One patient had complete resolution of clinical symptoms but refused follow-up angiography. Another patient had 50% decrease in fistula flow on the follow-up angiogram and improvement in clinical symptoms. Two patients had complete fistula obliteration after embolization and progressive improvement in symptoms but follow-up angiograms had not been obtained. Follow-ups ranged from 1 to 97 months (mean, 15 months). Two complications were related to this treatment. An embolic stroke followed transient placement of a balloon in the internal carotid in one patient, and a second patient developed transient visual loss when the venous outflow pathways were occluded before fistula closure. The fistula was immediately closed with complete recovery of vision. With recent advances in microcatheter and embolic agent technology, transvenous closure of cavernous dural fistulas is now possible.(ABSTRACT TRUNCATED AT 250 WORDS)
由于海绵窦硬脑膜瘘动脉栓塞存在风险，我们一直在寻找促进瘘口闭合的替代方法。13例患者接受经静脉栓塞治疗有症状的海绵窦硬脑膜瘘。所有手术均通过股静脉经岩下窦或基底静脉丛进行。5例患者血管造影未显示岩下窦；然而，仍有2例患者可通过该途径进行栓塞。使用的栓塞剂包括：1例患者使用可脱性球囊，5例仅使用弹簧圈，4例使用弹簧圈和液体黏合剂，1例使用弹簧圈加丝线缝合，1例仅使用丝线缝合，1例仅使用液体黏合剂。9例患者进行了随访血管造影，结果显示瘘口完全闭塞，相关症状完全缓解。1例患者临床症状完全缓解，但拒绝接受随访血管造影。另1例患者随访血管造影显示瘘口血流量减少50%，临床症状改善。2例患者栓塞后瘘口完全闭塞，症状逐渐改善，但未进行随访血管造影。随访时间为1至97个月（平均15个月）。该治疗出现了2例并发症。1例患者在颈内动脉短暂放置球囊后发生栓塞性卒中，另1例患者在瘘口闭合前闭塞静脉流出道时出现短暂视力丧失。瘘口立即闭合，视力完全恢复。随着微导管和栓塞剂技术的最新进展，现在经静脉闭合海绵窦硬脑膜瘘成为可能。（摘要截短至250字）
