小分支内。静脉入路的栓塞材料主要

    为: 微弹簧圈[6 ]

    、可脱性球囊、NBCA

    等。

    413 并发症: 动脉入路主要有: 误栓[18 ]

    、颅神经麻痹[18 ]

    、局部疼痛、局部感染等; 静

    脉入路主要有: 静脉栓塞[6 ]

    、静脉壁穿

    破[18 ]

    、眼上静脉栓塞[6 ]

    、颅内感染[19 ]

    等。

    414 疗效评价: 经动脉栓塞是治疗DAVF的

    有效方法[20 ]

    , 主要针对单瘘口或供血动脉较

    少的病人。在 DAVF 中, 无论瘘口多少, 供

    血动脉复杂程度怎样, 引流静脉多为一支,经静脉栓塞治疗, 能达到很好的疗效, 近年

    来报告其治愈率在不断提高。Roy 等[6 ]

    报告

    24例, 其影像学治愈率和临床治愈率分别为

    87 %和96 %; Goto 等[20 ]

    报告 17 例, 两者均

    达100 %。一系列最新报道, 经静脉入路治

    疗的疗效优于经动脉入路。Lucas

    [1 ]

    通过大宗

    病例分析表明, 对海绵窦区 DAVF , 经静脉

    入路 的 疗 效 ( 78 %) 优 于 经 动 脉 入 路

    (62 %) 。经静脉入路栓塞的优势主要在于:

    (1) 直接栓塞引流静脉及病窦, 封闭瘘口;

    (2) 避免了经动脉途径由于危险吻合所致的

    并发症。Irie

    [21 ]

    提出, 经静脉栓塞是治疗颅

    内DAVF 有效、安全的方法。Bellon 等[22 ]

    建

    议将静脉入路栓塞作为治疗 DAVF 的首选方

    法。

    5 参考文献:

    [ 1 ] Lucas CP , Zabramski JM, Spetzler RF , et

    al . Treatment for intracranial dural arteri2

    ovenous malformations : a meta - analysis

    from the English launguage literature [J ] .

    Neurosurgery , 1997 ; 40 (6) : 1119 - 321

    [ 2 ] Duffau H , Lopes M, Janosevic V , et al .

    Early rebleeding from intracranial dural arte2

    riovenous fistulas : report of 20 cases and re2

    view of the literature [ J ] . J Neurosurg ,1999 ; 90 ( 1 ) : 78 - 841

    [ 3 ] Van Di jk JM, TerBrugge KG, Willinsky

    RA , et al . Multiplicity of dural arteriove2

    nous fistulas [J ] . J Neurosurg , 2002 ; 96

    (1) : 76 - 81

    [ 4 ] Kiyosue H , Tanoue S , Okahara M, et al .

    Recurrence of dural arteriovenous fistula in

    another location after selective transvenous

    coil embolization : report of two cases [J ] .

    AJNR Am J Neuroradiol , 2002 ; 23 (4) :

    689 - 921

    [ 5 ] Hamada Y, Goto K, Inoue T. Histopatho2

    logical aspect of dural arteriovenous fistulas

    in the transverse - sigmoid sinus region in

    nine patients [ J ] . Neurosurgery , 1997 ;

    40 (3) : 452 , 456 - 81

    [ 6 ] Roy D , Raymond J . The role of transvenous

    embolization in the treatment of intracranial

    dural arteriovenous fistulas [ J ] . Neuro2

    surgery , 1997 ; 40 (6) : 1133 - 441

    [ 7 ] Terada T , Randall T , Grant B , et al . De2

    velopment of acquired arteriovenous fistulas

    in rats due to venous hypertension [ J ] . J

    Neurosurg , 1994 ; 80 (5) : 884 - 911

    [ 8 ] Chung SJ , KimJS , KimJC , et al . Intracra2

    nial dural arteriovenous fistulas : analysis of

    60 patients [ J ] . Cerebrovasc Dis , 2002 ;

    13 (2) : 79 - 881

    [ 9 ] Lawton MT , Jacobowitz R , Spetzler RE.

    Redefined role of angiogenesis in the patho2

    genesis of dural arteriovenous malformations

    [J ] . J Neurosurg , 1997 ; 87 (2 ) : 267 -

    741

    [10 ] Cognard C , Houdart E , Casascd AE , et

    al . Endovascular therapy and long - term

    results of intracranial dural arteriovenous fis2

    tulas. In : Connors JJ III , Wojak JC , eds.

    Interventional Neuroradiology : strategies and

    practical techniques [ J ] . Hrcourt Asia

    Sounder WB , 2001 , 198 - 2141

    [11 ] Sakaki T , Morimoto T , Nakase H , et al .

    Dural arteriovenous fistula of the posterior

    fossa developing after surgical occlusion of

    the Sigmoid Sinus : report of five cases [J ] .

    J Neurosurg , 1996 ; 84 (1) : 113 - 181

    [12 ] Olteanu Nerbe V , Uhl E , Steiger HJ . Dural

    arteriovenous fistulas including the transverse

    and sigmoid sinuses : results of treatment in ......