颈内动脉海绵窦瘘的DSA诊断及治疗
|
摘要
目的探讨颈内动脉海绵窦瘘的诊断和治疗，着重分析引流静脉与海绵窦的解剖结构。材料和方法回顾性的分析经DSA血管造影确诊的颈内动脉海绵窦瘘76例，观察分析颈内动脉海绵窦瘘的引流静脉的显示情况及其解剖学基础。其中21例行可脱性球囊、微弹簧圈血管内栓塞治疗，5例行外科手术。结果76例均经DSA血管造影作出了准确的诊断。经眼上静脉引流为主者72例(占94.7％)；经岩上、下窦引流者18例；经基底静脉引流者5例；经皮层静脉引流者15例；经海绵间窦向对侧海绵窦引流者8例。眼上静脉为颈内动脉海绵窦瘘的主要引流静脉。26例经血管内栓塞治疗和外科治疗后症状和体征消失。结论正确认识CCF的引流静脉有助于进一步加深对引流静脉与CCF临床表现的关系的认识及治疗方式的正确合理的选择。
[Abstract] Objective To investigate the diagnosis and treatment of internal carotid-cavernous fistulae(CCF),and the emphasis is to analyse the relationship between drainage venous and anatomy of cavernous sinus. Material and Methods 76 cases of CCF were reviewed .digital subtraction angiography(DSA) of cerebral arteries was carried out for diagnosis of all 76 cases ,and the anatomy of their venous drainage was studied. Of them,detachable balloon and microcoil were used for intravascular embolism treatment in 21 cases, and 5 cases were treated surgically. Results All 76 cases were diagnosesd by DSA, and venous drainaging mainly via superior ophthalmic vein was 72 cases(94 7%), 15 cases via cortical vein, 18 cases via petrosal sinus, 5 cases via Rosenthal vein, 10 cases via petrgoid plexus and 8 cases via controlateral cavernous sinus. The symptoms and signs of CCF disappeared after treatment in 26 cases. Conclusion It is very helpful to understand the relationship between venous drainage and clinical feature
and select the methods of treatment of CCF to analyse their drainage venous properly.
[Abstract] Objective To investigate the diagnosis and treatment of internal carotid-cavernous fistulae(CCF),and the emphasis is to analyse the relationship between drainage venous and anatomy of cavernous sinus. Material and Methods 76 cases of CCF were reviewed .digital subtraction angiography(DSA) of cerebral arteries was carried out for diagnosis of all 76 cases ,and the anatomy of their venous drainage was studied. Of them,detachable balloon and microcoil were used for intravascular embolism treatment in 21 cases, and 5 cases were treated surgically. Results All 76 cases were diagnosesd by DSA, and venous drainaging mainly via superior ophthalmic vein was 72 cases(94 7%), 15 cases via cortical vein, 18 cases via petrosal sinus, 5 cases via Rosenthal vein, 10 cases via petrgoid plexus and 8 cases via controlateral cavernous sinus. The symptoms and signs of CCF disappeared after treatment in 26 cases. Conclusion It is very helpful to understand the relationship between venous drainage and clinical feature
and select the methods of treatment of CCF to analyse their drainage venous properly.
引文
1．凌锋。介入神经放射学。人民卫生出版社，1991；86-87
2．刘承基。脑血管病的外科治疗。江苏科技出版社，1997：160
3．黄永火，绕克随，曾泳明，等。颈动脉海绵窦瘘血管造影及治疗研究。中国医学影像学杂志，1997；5(1)：53-54
4. Desal H, Leaute F, Auffray CE, et al. Direct carotid—cavernous fistula clinical radiologic and therapeutic studies. J Neuroradiol, 1997, 24(2): 141
5．欧阳墉。数字减影血管造影诊断学。人民卫生出版社，200175—81：404
6．刘才兴，吴怀清，扬卫忠，等。颈动脉海绵窦瘘的血管造影及临床分析。福建医科大学学报，1998；32(2)；181-182
7. Barrow DL, Spector RH, Braun IF, et al. Classification and treatment of spontaneous carotid-cavernous sinus fistula. Neuros, 1985; 62:248
8．刘作勤，王振亭，胡安常。颈动脉海绵窦瘘的介入治疗。山东医药，1997；37(11)；37
9．宣芸，李云生，于志强，等。海绵窦的解剖学研究及临床意义。天津医科大学学报，2000；6(4)：399-401
10．魏德，李铁林，徐达佳，等。经眼上静脉入路行海绵窦栓塞的应用解剖学。中国临床解剖学杂志，1998；16(1)；10-12
11．马立成。引流至海绵窦前部间隙的眼静脉：显微解剖关系。国外医学，脑血管疾病分册，1997；5(4)：236-237
12. Spektor S, Pointer I, Umansky F. Orbital venous draionage into the anterior cavernous sinus space: microanatomic relationships. Neurosurgery, 1997, Mar; 40(30;532-9
13．张绍祥，刘玉津，何光虎。海绵窦手术入路解剖学。解剖科学进展，1998；4(4)；333-336
14．张仕瑞，陈丽光，张广舒。彩色多谱勒血流显像对海绵窦动静脉瘘的诊断。中国实用眼科杂志，1996，14：491-492
15．黄品同，黄福光，吕夕明。颈动脉海绵窦瘘的彩色多谱勒超声研究。临床超声学杂志，2001；3(3)：134-135
16．漆剑频，陈劲草，张苏明。外伤性颈内动脉海绵窦瘘及介入治疗。中国神经外科杂志，2001；6(1)：7-8
17．邵良，陈道莅，朱晓江，等。颈动脉海绵窦瘘的诊治方法探讨。中国临床神经外科杂志，1999；4(3)；43
18．胡燕飞，王仲均，全伟，等。数字减影血管造影对海绵窦瘘的诊断及其血管内。中华眼科杂志，1999；35(3)：198
19．单鸿，罗鹏飞，李彦豪。临床介入诊疗学。广东科技出版社，1997：158-160
20. Lewis AI, Tomsick TA, Tew JM, et al. Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons. J Neurosurg, 1996; 84(3):400-4
21. Miller NR, Monsein LH, Debrun GM. Teatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg, 1995;83:838-842
22. Spineli HM, Falcone S, Lee G. Orbital venous approach to the cavernous sinus: an analysis of the facial and orbital venous system. Ann Plast Surg., 1994; 33:377-384
23. Monsein LH, Debrun GM, Miller NR. Treatment of dural carotid-cavernous fistulas via the superior ophthalmic vein. AJNR, 1991; 12:435
24. Mizobuchi M, Mino S, Nagao S, et al. Carotid-cavernous fistula successfully treated with embolization and radiation therapy: repot of three cases. N o Shinkei Geka, 1991; 19(1):83-87
25. Weber W, Henkes H, Berg-Dammer E, et al. Cure of a direct carotid-cavernous fistula by endovascular stent deployment. Cerebrovasc Dis, 2001; 12(3): 272-275
2．刘承基。脑血管病的外科治疗。江苏科技出版社，1997：160
3．黄永火，绕克随，曾泳明，等。颈动脉海绵窦瘘血管造影及治疗研究。中国医学影像学杂志，1997；5(1)：53-54
4. Desal H, Leaute F, Auffray CE, et al. Direct carotid—cavernous fistula clinical radiologic and therapeutic studies. J Neuroradiol, 1997, 24(2): 141
5．欧阳墉。数字减影血管造影诊断学。人民卫生出版社，200175—81：404
6．刘才兴，吴怀清，扬卫忠，等。颈动脉海绵窦瘘的血管造影及临床分析。福建医科大学学报，1998；32(2)；181-182
7. Barrow DL, Spector RH, Braun IF, et al. Classification and treatment of spontaneous carotid-cavernous sinus fistula. Neuros, 1985; 62:248
8．刘作勤，王振亭，胡安常。颈动脉海绵窦瘘的介入治疗。山东医药，1997；37(11)；37
9．宣芸，李云生，于志强，等。海绵窦的解剖学研究及临床意义。天津医科大学学报，2000；6(4)：399-401
10．魏德，李铁林，徐达佳，等。经眼上静脉入路行海绵窦栓塞的应用解剖学。中国临床解剖学杂志，1998；16(1)；10-12
11．马立成。引流至海绵窦前部间隙的眼静脉：显微解剖关系。国外医学，脑血管疾病分册，1997；5(4)：236-237
12. Spektor S, Pointer I, Umansky F. Orbital venous draionage into the anterior cavernous sinus space: microanatomic relationships. Neurosurgery, 1997, Mar; 40(30;532-9
13．张绍祥，刘玉津，何光虎。海绵窦手术入路解剖学。解剖科学进展，1998；4(4)；333-336
14．张仕瑞，陈丽光，张广舒。彩色多谱勒血流显像对海绵窦动静脉瘘的诊断。中国实用眼科杂志，1996，14：491-492
15．黄品同，黄福光，吕夕明。颈动脉海绵窦瘘的彩色多谱勒超声研究。临床超声学杂志，2001；3(3)：134-135
16．漆剑频，陈劲草，张苏明。外伤性颈内动脉海绵窦瘘及介入治疗。中国神经外科杂志，2001；6(1)：7-8
17．邵良，陈道莅，朱晓江，等。颈动脉海绵窦瘘的诊治方法探讨。中国临床神经外科杂志，1999；4(3)；43
18．胡燕飞，王仲均，全伟，等。数字减影血管造影对海绵窦瘘的诊断及其血管内。中华眼科杂志，1999；35(3)：198
19．单鸿，罗鹏飞，李彦豪。临床介入诊疗学。广东科技出版社，1997：158-160
20. Lewis AI, Tomsick TA, Tew JM, et al. Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons. J Neurosurg, 1996; 84(3):400-4
21. Miller NR, Monsein LH, Debrun GM. Teatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg, 1995;83:838-842
22. Spineli HM, Falcone S, Lee G. Orbital venous approach to the cavernous sinus: an analysis of the facial and orbital venous system. Ann Plast Surg., 1994; 33:377-384
23. Monsein LH, Debrun GM, Miller NR. Treatment of dural carotid-cavernous fistulas via the superior ophthalmic vein. AJNR, 1991; 12:435
24. Mizobuchi M, Mino S, Nagao S, et al. Carotid-cavernous fistula successfully treated with embolization and radiation therapy: repot of three cases. N o Shinkei Geka, 1991; 19(1):83-87
25. Weber W, Henkes H, Berg-Dammer E, et al. Cure of a direct carotid-cavernous fistula by endovascular stent deployment. Cerebrovasc Dis, 2001; 12(3): 272-275
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |