背景:颈动脉海绵窦瘘(CCF)很少见,通常跟随头部外伤或动脉瘤破裂。最近的治疗选择包括血管内技术,例如分流装置(FDD)。
目的:介绍我们使用经动脉海绵窦盘绕的FDD治疗的病例,并对FDD在CCF治疗中的使用和有效性进行系统评价。
方法:我们介绍了用FDD治疗CCF的病例。在PubMed也进行了搜索,EMBASE和Cochrane,直到2020年11月。参考列表也进行了交叉检查。
结果:包括我们的案例,在16项研究中,38例患者被确定为CCF,并接受FDDs治疗。22名患者是女性,九人是男性,其余身份不明。平均年龄为52,6岁(范围17-86,SD±19.28)。36例患者患有直接CCF,2例患有间接CCF。在四个案例中使用了单一FDD,11例单发FDD伴栓塞材料,6例患者使用多重重叠FDDs,17例患者使用多重重叠FDDs与栓塞材料.35名患者(92,1%)有临床改善,在44,7%的病例中发现了立即的血管造影闭塞,虽然长期闭塞率为100%,但随访时间不同。一名患者(2,6%)出现与FDD部署有关的神经功能缺损。
结论:使用或不使用辅助栓塞剂的单一或重叠FDDs靶向治疗CCFs的成功率很高,与其他单独的血管内方法相比,临床和长期血管造影。然而,有必要进行多中心前瞻性试验的进一步研究.
BACKGROUND: Carotid cavernous fistulas (CCFs) are rare, usually follow head trauma or aneurysmal rupture. Recent treatment options include endovascular techniques such as flow diversion devices (FDDs).
OBJECTIVE: To present our case treated with FDD application with transarterial cavernous-sinus coiling and present a systematic
review on the use and effectiveness of FDDs in CCF treatment.
METHODS: We present our case of CCF treatment with FDD. A search was also conducted in PubMed, EMBASE and Cochrane until November 2020. Reference lists were also cross-checked.
RESULTS: Including our case, thirty-eight patients were identified with a CCF that was treated with FDDs in sixteen studies. Twenty-two patients were females, nine were males and the rest unidentified. The mean age was 52,6 years (range 17-86, SD± 19.28). Thirty-six patients suffered from direct and two from indirect CCFs. Single FDD was used in four cases, single FDD with embolic materials in eleven cases, multiple overlapping FDDs were used in six cases and multiple overlapping FDDs with embolic materials were used in seventeen cases. Thirty-five patients (92,1%) had clinical improvement, immediate angiographic occlusion was seen in 44,7% of the cases, while long-term occlusion rate was 100% but with variable follow-up periods. One patient (2,6%) presented with a neurological deficit related to FDD deployment.
CONCLUSIONS: Targeted treatment of CCFs with single or overlapping FDDs with or without adjunct embolic agents offers a high success rate, both clinically and long-term angiographically compared to other endovascular methods alone. However, further research with multi-center prospective trials is warranted.