Departments of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Division of Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, 120-752, Seodaemun-gu, Seoul, South Korea.
BMC Neurol. 2021 Jan 20;21(1):31. doi: 10.1186/s12883-021-02046-6.
This study aimed to evaluate the efficacy and safety of Scepter dual-lumen balloon catheter for transarterial Onyx embolization of dural arteriovenous fistula (DAVF).
Transarterial Onyx embolization using a Scepter dual-lumen balloon catheter (Scepter-assisted Onyx embolization) for DAVF was attempted in a total of 35 patients (mean age, 52.5 years; M:F = 24:11) between October 2012 and December 2018. The results of Scepter-assisted Onyx embolization were evaluated with respect to total procedural and Onyx injection times, the types and number of feeders requiring embolization, angiographic and clinical outcomes, and treatment-related complications.
Initial presentations were non-hemorrhagic neurological deficits in 10, intracranial hemorrhage in 8, seizure in 7, headache in 7, and intractable tinnitus in 3. All DAVF were aggressive type (Borden type 2, 14.3 %; type 3, 85.7 %). Scepter-assisted Onyx embolization resulted in immediately complete occlusion in 33 patients (94.3 %) and near complete occlusion in 2 patients. Middle meningeal artery (51.4 %) was the most commonly used for Scepter-assisted technique, followed by occipital artery (42.9 %), ascending pharyngeal artery (2.9 %) and superficial temporal artery (2.9 %). There was no difference in complete occlusion rate between middle meningeal artery and the other arteries (94.4 % versus 94.1 %). The median number of total feeders embolized was 1 (range, 1-3). The median total procedural time was 45 minutes (range, 21 minutes - 127 minutes) and the median Onyx injection time was 11 minutes (range, 3 minutes - 25 minutes). All patients recovered completely (n = 31) or partially (n = 4) from presenting symptoms. Treatment-related complications occurred in 2 patients, of whom one had a permanent morbidity (2.8 %, ipsilateral facial nerve palsy). No patient showed a recurrence on follow-up imaging (median, 15 months; range, 3-56 months).
Scepter-assisted transarterial Onyx embolization showed a very high complete occlusion rate with a low morbidity and no recurrence in aggressive type DAVF. Scepter dual-lumen balloon catheter seems to be a useful tool for transarterial Onyx embolization of DAVF.
本研究旨在评估 Scepter 双腔球囊导管在经动脉 Onyx 栓塞治疗硬脑膜动静脉瘘（DAVF）中的疗效和安全性。
2012 年 10 月至 2018 年 12 月，共对 35 例患者（平均年龄 52.5 岁；M:F=24:11）采用 Scepter 双腔球囊导管（Scepter 辅助 Onyx 栓塞）进行经动脉 Onyx 栓塞治疗。评估 Scepter 辅助 Onyx 栓塞的结果包括总手术时间和 Onyx 注射时间、需要栓塞的供血动脉的类型和数量、血管造影和临床结果以及与治疗相关的并发症。
首发症状为非出血性神经功能缺损 10 例，颅内出血 8 例，癫痫发作 7 例，头痛 7 例，难治性耳鸣 3 例。所有 DAVF 均为侵袭性类型（Borden 2 型，14.3%；3 型，85.7%）。Scepter 辅助 Onyx 栓塞即刻完全闭塞 33 例（94.3%），近完全闭塞 2 例。最常使用的 Scepter 辅助技术是脑膜中动脉（51.4%），其次是枕动脉（42.9%）、咽升动脉（2.9%）和颞浅动脉（2.9%）。脑膜中动脉和其他动脉的完全闭塞率无差异（94.4%比 94.1%）。栓塞的总供血动脉中位数为 1 条（范围 1-3 条）。总手术时间中位数为 45 分钟（范围 21 分钟-127 分钟），Onyx 注射时间中位数为 11 分钟（范围 3 分钟-25 分钟）。所有患者均完全（n=31）或部分（n=4）从首发症状中恢复。2 例患者发生与治疗相关的并发症，其中 1 例出现永久性并发症（2.8%，同侧面神经麻痹）。随访影像学检查未见复发（中位数 15 个月；范围 3-56 个月）。
Scepter 辅助经动脉 Onyx 栓塞治疗侵袭性 DAVF 具有非常高的完全闭塞率、较低的发病率和无复发。Scepter 双腔球囊导管似乎是经动脉 Onyx 栓塞治疗 DAVF 的有用工具。
