【摘要】 目的探讨血管内介入治疗创伤性颈动脉海绵窦瘘(TCCF)的策略及预后。方法回顾性分析2012年6月—2018年12月在中南大学湘雅二医院神经外科接受血管内介入治疗的24例TCCF患者临床资料、血管内治疗策略及预后,其中男性13例,女性11例,年龄18～79岁,平均46.3岁。均有明确的头面部创伤史,时间3d～10年。结果 24例患者行栓塞治疗25次,其中单独使用可脱球囊经动脉治疗4例,1例在治疗后1d出现球囊移位,在闭塞试验代偿良好的情况下,继而闭塞病变侧颈内动脉;球囊保护下弹簧圈加Onyx胶经动脉栓塞治疗15例,弹簧圈加Onyx胶经静脉栓塞治疗2例,使用覆膜支架治疗2例,直接接受病变侧颈内动脉闭塞治疗1例。术后颅内杂音均消失,随访时间6个月～6年,平均44.8个月,搏动性突眼、球结膜充血、视力下降均得到不同程度缓解;6例复视患者中2例永久性外展受限;2例眼睑下垂好转,其中1例新发外展受限,1年后好转;5例头晕好转。结论血管内介入是TCCF主要及有效的治疗手段,随着介入技术发展及材料的更新,TCCF患者应得到个体化血管内治疗。更多还原

【Abstract】 Objective To explore the strategy and prognosis of endovascular treatment for traumatic carotid cavernous fistula(TCCF). Methods The clinical data of 24 TCCF patients who have underwent endovascular treatment in our department of neurosurgery were collected retrospectively and their therapeutic strategy and prognosis were analyzed. Among them,there were 13 males and 11 females, with an average age of 46.3 years(18-79 years). All had history of head trauma(3 days-10 years).Results Twenty-four patients were treated for 25 times. Among the 24 cases,detachable balloon were used in 4 cases alone(one patient had balloon displacement one day after treatment,and then occluded the ipsilateral internal carotid artery),coils and Onyx were used in 15 cases via artery with balloon protection,coils and Onyx were used in 2 cases via vein,covered stent was used in 2 cases,and ipsilateral internal carotid artery occlusion was used in 1 case. The intracranial murmur disappeared after treatment,and the follow-up period ranged from 6 months to 6 years(mean 44.8 months). The pulsatile exophthalmos,conjunctival hyperemia and vision impairment were recovered in varying degrees. Permanent paralysis of the abducens nerve was limited in 2 of the 6 patients with diplopia. Blepharoptosis was improved in 2 cases,among them new paralysis of the abducens nerve appeared in 1 case and was improved after 1 year. Dizziness was improved in 5 cases. Conclusion Endovascular therapy is the main and effective treatment for TCCF. With the development of endovascular treatment techniques and the updating of materials,patients with TCCF should receive individualized endovascular treatment.更多还原