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目的评价经静脉入路栓塞治疗横窦-乙状窦区硬脑膜动静脉瘘(DAVF)的安全性和有效性。方法经静脉入路到达患侧的横窦-乙状窦,用微弹簧圈填塞病变静脉窦,同时闭塞瘘口。结果经静脉入路治疗横窦-乙状窦区DAVF共16例。病变累及横窦-乙状窦交界处者11例、横窦者3例、乙状窦者2例。根据Cognard分类,IIa型3例,IIb型1例,IIa+b型12例。单纯应用静脉入路7例,经静脉入路前先采用经动脉途径栓塞者8例,经静脉入路栓塞治疗后再经动脉途径栓塞者1例。瘘口完全闭塞13例,瘘口残留3例,但瘘口流量已减少95%以上。15例(94%)在栓塞治疗后临床症状消失,1例栓塞后出现颅内出血死亡,未见其他并发症。随访4～23个月,临床症状无复发。11例行造影复查:3例残留瘘口者2例消失,1例曾行3次造影复查瘘无明显变化,由于无临床症状,未再行栓塞治疗;另外8例造影复查未见复发。结论对于适当选择的横窦-乙状窦区DAVF病例,经静脉入路闭塞病变静脉窦是一种安全有效的治疗方法。
Objective To evaluate the safety and efficacy of transcatheter arterial embolization in the treatment of transverse sinusoidal sinusoidal dural arteriovenous fistula (DAVF). Methods The transversal sinus - sigmoid sinus reached the affected side through the vein, and the diseased sinus was occluded with a coil spring, and the fistula was occluded. Results The transvenous approach for the treatment of transverse sinus - sigmoid sinus DAVF a total of 16 cases. Lesions involving the transverse sinus - sigmoid sinus junction in 11 cases, 3 cases of transverse sinus, sigmoid sinus in 2 cases. According to the Cognard classification, there were 3 cases of type IIa, 1 case of type IIb and 12 cases of type IIa + b. Simple application of intravenous approach in 7 cases, before the intravenous approach by artery embolization in 8 cases, after intravenous embolization and arterial embolism in 1 case. Fistula completely occluded in 13 cases, 3 cases of residual fistula, but the fistula flow has been reduced by 95% or more. Fifteen patients (94%) disappeared after embolization, and one patient died of intracranial hemorrhage after embolization. No other complications were found. Followed up for 4 ~ 23 months, no recurrence of clinical symptoms. 11 routine radiographic review: 3 cases of residual fistula disappeared in 2 cases, 1 case had 3 times retrospective fistula no significant change, because no clinical symptoms, no further embolization; the other 8 cases of angiography recurred no recurrence. Conclusions For DAVF cases of transverse sinus - sigmoid sinuses, the venous sinus is a safe and effective method for the occlusion of sinuses.