外伤性颈动脉海绵窦瘘伴颅内出血急诊血管内介入治疗

目的探讨表现为颅内出血（ICH）的外伤性颈动脉海绵窦瘘（CCF）的临床特点和急诊血管内介入治疗方式。方法回顾性分析2010年1月—2017年4月苏州大学附属第二医院收治的5例表现为ICH的CCF患者的临床资料，均有明确的头部创伤史，并经头部计算机断层扫描确认为ICH。所有病例均经数字减影血管造影确诊为颈动脉海绵窦瘘，并行急诊血管内介入治疗。所有患者门诊随访，评估临床预后。结果5例患者均为单侧颈动脉海绵窦瘘，2例采用可脱性球囊栓塞，2例采用可脱性弹簧圈栓塞，1例采用Onyx胶联合可脱性弹簧圈栓塞。1例经二次可脱性球囊栓塞治愈，另4例均一次性治愈。所有患者随访3～10年，均未再发生ICH及症状复发；1例颈内动脉迟发性闭塞，其余均获得保留。结论表现为ICH的颈动脉海绵窦瘘临床过程急重，需急诊行血管内介入治疗；根据病灶的不同特点个体化地选择相应的治疗措施是安全、有效的。

Objective To investigate the clinical characteristics and emergent endovascular treatment for traumatic carotid cavernous fistula(CCF) presenting intracranial hemorrhage（ICH）. Method The clinical data of totally 5 CCF patients with definite history of head injury admitted to Second Affiliated Hospital of Soochow University from January 2010 to April 2017, of which ICH were confirmed by head computed tomography, were analyzed retrospectively. Digital subtraction angiography was carried out in all cases for diagnosis and further emergent endovascular treatment. The clinical outcomes were assessed during out-patient follow up. Results All 5 patients were diagnosed with unilateral CCF, of which 2 were obliterated with detachable balloons, 2 with detachable coils, and 1 with detachable coils and Onyx glue. 4 cases were cured in one stage, 1 in second stage with detachable balloon. During 3 to 10 years follow-up, no ICH or recurrence of symptoms occurred in all cases, except delay occlusion of parent artery in one. Conclusions Emergent endovascular therapy is indicated for CCF presenting ICH. Individualized treatment according to different characteristic of CCF lesions is safe and effective.