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目的介绍远端血管阻断辅助微导管超选技术在经动脉入路栓塞硬脑膜动静脉瘘术中的应用。方法硬脑膜动静脉瘘患者2例。1例为天幕缘区硬脑膜动静脉瘘,供血动脉来自脑膜中动脉和枕动脉,采用弹簧圈闭塞枕动脉远端主干。另一例为前颅窝底硬脑膜动静脉瘘,供血动脉为双侧眼动脉之筛前、筛后动脉,采用球囊临时阻断于颈内动脉眼动脉开口远端。结果微导管在弹簧圈及球囊支撑下均超选入与主干血管成角明显且迂曲的供血动脉远端,微导管头端接近瘘口,以液态栓塞材料完全消除瘘口。结论对于供血动脉迂曲且与主干血管成角明显的硬脑膜动静脉瘘,远端血管临时或永久阻断有利于使微导管头端超选至理想位置,最终保证瘘口栓塞。
Objective To introduce the application of distal vessel occlusion assisted microcatheter surgeries in the arteriovenous fistula of the dural embolization via arterial approach. Methods Two cases of dural arteriovenous fistula. One case was cephalic dural arteriovenous fistula, the feeding artery was from the middle meningeal artery and the occipital artery, and the circlip was used to occlude the distal trunk of the occipital artery. Another example is the anterior cranial fossa dural arteriovenous fistula, the feeding artery for the bilateral ophthalmic artery before and after the sieve artery, the balloon temporarily occluded in the distal end of the opening of the internal carotid artery. Results The microcatheter was surgically inserted into the distal end of the feeding artery which was angled with the main blood vessel under the support of the coil and the balloon. The tip of the microcatheter was close to the fistula and the fistula was completely eliminated by the liquid embolic material. Conclusions For dural arteriovenous fistula, which is tortuous and has an obvious angle with the main blood vessel, temporary or permanent obstruction of the distal blood vessel can facilitate superselecting the tip of the microcatheter to an ideal position and ultimately ensure the embolization of the fistula.