Miller N R, Monsein L H, Debrun G M, Tamargo R J, Nauta H J
Neuro-Ophthalmology Unit, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Neurosurg. 1995 Nov;83(5):838-42. doi: 10.3171/jns.1995.83.5.0838.
The authors describe the method and results of treatment of 12 consecutive patients with carotid-cavernous sinus fistulas (CCFs). Treatment was by embolization via a transvenous approach through the superior ophthalmic vein (SOV). The CCFs (two direct and 10 dural) had previously been treated unsuccessfully or, for mechanical reasons, could not be treated by the standard techniques of endoarterial balloon occlusion, particle or glue embolization of feeding vessels from one or both external carotid arteries, or transvenous occlusion of the fistula via the ipsilateral inferior petrosal sinus. All 12 patients were successfully treated either by advancement of a detachable balloon catheter through the ipsilateral SOV into the cavernous sinus with subsequent inflation and detachment of the balloon (11 patients) or by introduction of multiple thrombogenic coils into the fistula via the ipsilateral SOV (one patient). All patients had complete resolution of symptoms and signs after successful occlusion of the CCF. There were no intraoperative complications; however, one patient required postoperative embolization of a residual posteriorly draining fistula via the ipsilateral external carotid artery, and another developed a persistent abducens nerve paresis that eventually required surgical correction. Ten (83.3%) of the 12 patients underwent cerebral angiography 3 to 6 months after surgery, and none showed evidence of a recurrent fistula. Similarly, none of the 12 patients developed recurrent symptoms and signs suggesting recurrence of the fistula during a follow-up period that ranged from 6 months to 10 years (mean 64 months). It is concluded that the transvenous approach to the cavernous sinus through the SOV is a safe and effective treatment of both direct and dural CCFs that are not amenable to transarterial or other transvenous approaches.
作者描述了连续12例海绵窦瘘（CCF）患者的治疗方法及结果。治疗采用经眼上静脉（SOV）经静脉途径进行栓塞。这些CCF（2例直接型和10例硬脑膜型）此前治疗失败，或因机械原因无法采用经动脉球囊闭塞、来自一侧或双侧颈外动脉的供血血管颗粒或胶水栓塞，或经同侧岩下窦经静脉闭塞瘘管等标准技术进行治疗。12例患者均成功治疗，其中11例通过将可脱性球囊导管经同侧SOV推进至海绵窦，随后充盈并解脱球囊；1例通过经同侧SOV向瘘管内引入多个致血栓形成的弹簧圈。CCF成功闭塞后，所有患者的症状和体征均完全消失。术中无并发症发生；然而，1例患者术后需要经同侧颈外动脉对残留的后引流瘘管进行栓塞，另1例出现持续性展神经麻痹，最终需要手术矫正。12例患者中有10例（83.3%）在术后3至6个月接受了脑血管造影，均未显示复发瘘管的迹象。同样，12例患者在6个月至10年（平均64个月）的随访期内均未出现提示瘘管复发的复发症状和体征。结论是，经SOV经静脉途径进入海绵窦是治疗不适合经动脉或其他经静脉途径治疗的直接型和硬脑膜型CCF的一种安全有效的方法。
