背景:多次经静脉尝试后未能到达海绵窦,虽然罕见,对神经干预学家来说可能是个挑战。作者试图证明通过眼上静脉(SOV)直接线圈栓塞间接颈动脉海绵窦瘘(CCF)的新型混合手术和血管内经血管入路的独立性能的技术考虑和细微差别。他们回顾了关于经椎入路的大量文献。
方法:一个说明性案例,包括病史和介绍,已审查。PubMed,MEDLINE,我们在Embase数据库中搜索了2000年1月1日至2021年9月30日发表的文章,这些文章报道了≥1例CCF患者通过SOV途径进行血管内治疗.提取的数据包括样本量,治疗方式,外科技术,执行外科医生专业,和程序结果。作者的案例说明演示了混合经椎入路的技术。对于审查,确定了273篇独特文章;14篇包含74名接受治疗的患者符合纳入标准。眼整形手术是最常见的专业(14项研究中有5项),其次是眼科(14个中的3个)。在12项研究中,仅卷绕是选择的治疗方法,在2中辅助使用Onyx(Medtronic)。
结论:作者\'技术案例描述,视频,插图,和综述为血管内神经外科医生提供了独立进行手术的系统指导。
BACKGROUND: Failure to reach the cavernous sinus after multiple transvenous attempts, although rare, can be challenging for neurointerventionists. The authors sought to demonstrate technical considerations and nuances of the independent performance of a novel hybrid surgical and endovascular transpalpebral approach through the superior ophthalmic vein (SOV) for direct
coil embolization of an indirect carotid cavernous fistula (CCF), and they review salient literature regarding the transpalpebral approach.
METHODS: An illustrative
case, including patient history and presentation, was reviewed. PubMed, MEDLINE, and Embase databases were searched for articles published between January 1, 2000, and September 30, 2021, that reported ≥1 patient with a CCF treated endovascularly via the SOV approach. Data extracted included sample size, treatment modality, surgical technique, performing surgeon specialty, and procedure outcome. The authors\'
case illustration demonstrates the technique for the hybrid transpalpebral approach. For the review, 273 unique articles were identified; 14 containing 74 treated patients fulfilled the inclusion criteria. Oculoplastic surgery was the most commonly involved specialty (5 of 14 studies), followed by ophthalmology (3 of 14). Coiling alone was the treatment of choice in 12 studies, with adjunctive use of Onyx (Medtronic) in 2.
CONCLUSIONS: The authors\' technical
case description, video, illustrations, and review provide endovascular neurosurgeons with a systematic guide to conduct the procedure independently.