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目的推介最近5年经动脉途径使用可脱球囊、弹簧圈和Willis覆膜支架血管内治疗外伤性直接性颈动脉海绵窦瘘(TDCCFs)和保留颈内动脉(ICA)的经验。方法回顾性分析经动脉途径血管内治疗的51例患者的54处TDCCFs,均首选可脱球囊作为治疗方法,Willis覆膜支架和弹簧圈作为备选方法,术后3～48个月行脑血管造影和临床随访评价所有患者的治疗效果。结果一期单纯性可脱球囊成功治疗46处(85.2%)TDCCFs,并保留了ICA。使用可脱球囊、弹簧圈和Willis覆膜支架合计保留了53处(98.1%)TDCCFs的ICA,同时成功闭塞瘘口,仅1例闭塞了单侧ICA和瘘口。单纯可脱球囊治疗40处TDCCFs,单纯Willis覆膜支架治疗2处TDCCFs,单纯弹簧圈治疗1处TDCCF,可脱球囊联合Willis覆膜支架治疗8处TDCCFs,联合弹簧圈治疗3处TDCCFs,其中1处使用了Willis覆膜支架治疗。12处TDCCFs进行了二期和三期治疗。除外5例患者单侧视力损害和(或)脑神经麻痹无明显改善外,术后1 d～6个月其他病例症状呈阶梯型改善,直到消失。术中无一例患者血管破裂、无远端脑栓塞和新发神经系统症状等并发症。51处TDCCFs在最后1次治疗后6个月随访无复发。结论经动脉途径使用可脱球囊栓塞TDCCFs的瘘口和保留ICA仍然是其首选的方法,但当这个方法失败时,Willis覆膜支架和弹簧圈可以作为有效的替换方法或补救措施闭塞瘘口和保留ICA,而使用Willis覆膜支架是有效、安全和经济实用的治疗方法,但需更多的病例作远期随访,以进一步拓展它的适应证。
Objective To summarize the experience of endovascular treatment of traumatic direct carotid cavernous fistula (TDCCFs) and preservation of the internal carotid artery (ICA) with percutaneous balloon, coil and Willis stent in the recent 5 years. METHODS: Fifty-four TDCCFs in 51 patients undergoing intra-arterial endovascular treatment were retrospectively analyzed. The best choice of deflagable balloon was treated with Willis stent and coil as an alternative method. The brains were brains from 3 to 48 months after operation Angiography and clinical follow-up evaluation of the treatment effect of all patients. Results A single detachable debridement balloon successfully treated 46 (85.2%) TDCCFs and retained ICA. Fifty-three (98.1%) ICA of TDCCFs were retained with the detachable balloon, coil, and Willis stent, with a successful occlusion of the fistula and only one occlusion of the unilateral ICA and fistula. There were 40 TDCCFs treated with pure detachable balloon, 2 TDCCFs treated with Willis stent alone, 1 TDCCF treated with coil only, 8 TDCCFs treated with detachable balloon combined with Willis stent and 3 TDCCFs treated with coil, One of them was treated with Willis stent. Twelve TDCCFs were treated with stage two and stage three. Except for 5 cases of unilateral visual impairment and / or cranial nerve paralysis no significant improvement, 1 d ~ 6 months after the other cases showed a ladder-like symptoms until disappear. No intraoperative blood vessel rupture, no distal cerebral embolism and new neurological symptoms and other complications. 51 TDCCFs had no recurrence at 6 months after the last treatment. Conclusions The use of detachable balloon embolization of the fistula and retention of ICA by the arterial approach remains the preferred method, but when this method fails, the Willis stent and coil can be used as an effective alternative or remedy to occlude the fistula And preserving the ICA, Willis stent is an effective, safe and economical treatment, but more cases need long-term follow-up to further expand its indications.