Robert Thomas, Valsecchi Daniele, Sylvestre Philippe, Blanc Raphaël, Ciccio Gabriele, Smajda Stanislas, Redjem Hocine, Piotin Michel
Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France; Department of Neurosurgery, Neurocenter of the Southern Switzerland, Hospital of Lugano, Lugano, Switzerland.
Department of Neurosurgery, Neurocenter of the Southern Switzerland, Hospital of Lugano, Lugano, Switzerland.
World Neurosurg. 2018 Aug;116:e246-e251. doi: 10.1016/j.wneu.2018.04.182. Epub 2018 May 3.
Sixth nerve palsy is a common complication of endovascular treatment for carotid-cavernous fistulas (CCF). Two hypotheses are evoked: the spontaneous venous congestion into the cavernous sinus and the direct compression of the nerve by the embolic agent into the cavernous sinus. Nevertheless, the evidence is still uncertain. Knowing the vicinity of the sixth nerve with the inferior petrosal sinus (IPS) in the Dorello canal, we hypothesized that the recanalization of the IPS increased the risk of nerve damage.
We analyzed a prospective database of patients treated for CCFs from March 2009 to April 2016. We excluded patients who did not need treatment, cases of high-flow CCF, and patients lost to follow-up, obtaining a homogeneous population of 82 patients with indirect CCFs. This population was divided in 2 groups: patients without new-onset/worsening of sixth nerve palsy and patients with this postprocedural complication.
Our main endpoints were the potential differences between patients with or without recanalization of IPS and between those who underwent or not an embolization with Onyx-18. We did not find any statistically meaningful difference between the 2 groups concerning the necessity of IPS recanalization (P > 0.999, odds ratio 0.97, 95% confidence interval 0.32-2.96) or with the use of Onyx-18 as an embolic agent (P = 0.56; odds ratio 1.41, 95% confidence interval 0.41-2.45).
The recanalization of a thrombosed IPS does not increase the risk of procedural sixth nerve damage. The initial injury seems to relate with development/worsening of a sixth nerve palsy.
第六脑神经麻痹是颈动脉海绵窦瘘（CCF）血管内治疗的常见并发症。有两种假说：海绵窦内的自发性静脉充血以及栓塞剂对海绵窦内神经的直接压迫。然而，证据仍不明确。鉴于第六脑神经在Dorello管内与岩下窦（IPS）相邻，我们推测IPS再通会增加神经损伤风险。
我们分析了2009年3月至2016年4月接受CCF治疗患者的前瞻性数据库。我们排除了无需治疗的患者、高流量CCF病例以及失访患者，得到了82例间接CCF患者的同质人群。该人群分为两组：第六脑神经麻痹无新发/加重的患者和有该术后并发症的患者。
我们的主要终点是IPS再通与否的患者之间以及使用或未使用Onyx - 18进行栓塞的患者之间的潜在差异。我们发现两组在IPS再通的必要性方面（P>0.999，比值比0.97，95%置信区间0.32 - 2.96）或使用Onyx - 18作为栓塞剂方面（P = 0.56；比值比1.41，95%置信区间0.41 - 2.45）均未发现任何具有统计学意义的差异。
血栓形成的IPS再通不会增加手术中第六脑神经损伤的风险。初始损伤似乎与第六脑神经麻痹的发生/加重有关。
