Debrun분리 풍선 카데타법에 의한 경동맥 해면동루의 치료

Treatment of Traumatic Carotid-Cavernous Fistulas using Debrun's Detachable Balloons

외상성 경동맥 해면동루의 치료를 위해 8명의 환자에서 Goldvalve형 풍선을 이용한 치료를 시도 하였다. 전 례에서 동맥을 통한 누공 폐색을 시도하여 성공적으로 누공을 폐색하였다. 5례에서는 내경동맥을 보존할 수 있었으나 다른 경우는 내경동맥과 누공을 함께, 내경동맥의 해면동부 전체, 그리고 일관성 흑내장 방지위해 내경동맥과 누공 도한 내경동맥 기시부를 함께 폐색시킨 예가 각각 1례씩 있었다. 누공만을 폐색시킨 1례에서 증상이 재발하여 수술로 치료하였다. 주요 합병증으로는 3례의 두통과 1례의 허혈성 편마비가 있었으나 자연소실 되었다. 이러한 결과를 볼 때 CCF는 분리풍선을 이용하여 누공만을 폐색시켜 치료하는 것이 유리할 것으로 생각된다.

The goal of therapy in patients with traumatic carotid-cavernous fistulas is to occlude the fistula, preferably while maintaining the carotid blood flow. Since the introduction of the concepts of detachable balloon technique to occlude arteriovenous fistulas, the technique has become the treatment of choice in the management of traumatic carotid-cavernous fistulas. The major symptoms of traumatic CCFs are (1)pulsating exophthalmos, (2)orbital and cephalic bruit and murmur, (3) headache, (4) chemosis. (5) extraocular palsies, and (6) visual failure. Traumatic CCFs are combined with multiple associated lesions. We tried the occlusion of fistulas using Goldvalve balloons in 8 consecutive cases of traumatic CCF and the result of our experience is reported. Transarterial approach with manually-tied latex balloons is tried in all cases and the fistulas was successfully occluded in all cases. In 5 cases. the internal carotid artery was preserved and the arterial lumen was occluded along with fistula opening in :3 cases. In one case, surgical ligation was done because of symptoms recurred and incomplete occlusion of fistula. We experienced hemiparesis as a major complication in one case during occlusion tolerance test, which was remitted spontaneously. The results of Debrun balloon treatment were relatively excellent. We consider that the first choice of treatment of traumatic CCF is occlusion of the fistula by a detachable balloons.