- 期刊
- OpenAccess
由內頸動脈和外頸動脈共同供血之海綿狀竇的動靜脈畸形
Arteriovenous Malformations of the Cavernous Sinus Fed by Dural Branches of both Internal and External Carotid Arteries
摘要
由內頸動脈和外頸動脈共同供血之海綿狀竇的動靜脈畸形無論用外科開刀或做栓塞術都極為困難。在過去五年，我們曾經治療過21例這種病人。其中9例經由上眼靜脈或同時經由上眼靜脈以及下岩寶對海綿狀寶做栓塞術；有10例用細導管深入外頸動脈之一供血血管以注入NSCA混合液治療，其中1例合併經由上眼靜脈栓塞使用。有3例我們在數個外頸動脈供血分支近端注入lvalon顆粒，其中1例合併經由上眼靜脈栓塞使用。一例在別處曾經使用lvalon顆粒對外頸動脈供血血管做過栓塞後，我們使用囊球以及NBCA混合液將內頸動脈以及其供血血管塞掉。 如能將海綿狀竇完全塞掉，從靜脈去對海綿狀竇做栓塞術會有效，但常難以將導管送到海綿狀竇。在外頸動脈供血分支近端注入lvalon顆粒最簡單但也最無效。細導管深入外頸動脈之一供血血管注入之NSCA混合液如能到達海綿狀竇會有效，但需用特殊之細導管，且須避免栓塞物經側副循環流入有用血管。
並列摘要
It is difficult to treat arteriovenous malformations of the cavernous sinus fed by dural branches of both internal and external carotid arteries. Over the past five years, we have treated 21 such cases. Cavernous sinus embolotherapy was conducted through the superior ophthalmic vein or the inferior petrosal sinus in 9 cases; and injected NBCA mixture through one distal external carotid artery feeder in 10 cases (cavernous sinus embolizafion through the superior ophthalmic vein was also used in one of them). Ivalon particles were injected through proximal external feeder in 3 cases (cavernous sinus embolization through the superior ophthalmic vein was done also in one of them). Occlusion of the internal carotid artery and its feeder to the arteriovenous malformation was done by placing detachable balloons and injecting NBCA mixture in the internal carotid artery in a patient who had received embolization of the external carotid feeders with Ivalon particles. Venous approach to occlude the cavernous sinus is effective if the cavernous sinus can be obliterated completely, but it is often difficult to get a catheter in the cavernous sinus. Nonselective catheterization of the ECA and embolization with Ivalon particles are technically easy, but the least effective. Delivery of NBCA mixture into a feeding external carotid feeder is often effective if the emboli can reach the cavernous sinus, but we have to prevent the emboli to enter into a functionally important artery through collateral circulation.