颈动脉海绵窦瘘的眼部表现与血管内治疗

目的 分析颈动脉海绵窦瘘的临床特点。评价血管内治疗的效果。方法 回顾分析１２例经全盘离血管造影证实为颈内动态海绵窦瘘患者的病史、眼部表现、临床检查的特点及进行可脱性球囊栓塞的疗效。结果 １２例患者１次栓塞成功者１０例（８３．３％）,２例行２次栓塞,术后无并发症,１例术前失明,术后１ｗｋ视力恢复至眼前手动。１０例视力较术前提高１～４行（Ｓｎｅｌｌｅｎ表）。术后眼部瘀血肿胀、眼球突出度均明显减轻或消失。眼球运动恢复正常,复视消失,视网膜出血吸收,眼部血管杂音全部消失。术后全脑血管造影复查,瘘口均封闭。结论 对于颈内动脉海绵窦瘘应及时治疗,尽快恢复视功能。彩色多普勒超声、ＣＴ、ＤＳＡ是诊断本病的常用手段。血管内栓塞是目前治疗颈动脉海绵窦瘘最为理想的方法。     

颈动脉海绵窦瘘的眼部表现与血管内治疗

目的：分析颈动脉海棉窦瘘的眼部临床特点，评价血管内治疗的效果。方法：回顾分析126例经全脑血管造影证实为颈动脉海绵窦瘘患的病史、眼部表现、临床特点及进行的可脱性球囊栓塞治疗。结果：手术1次性栓塞成功112例(88．9％)，14例行2次栓塞。术后无并发症。98例视力较术前提高1～4行(国际标准视力表)。术后眼部淤血肿胀、眼球突出度均明显减轻或消失，眼球运动恢复正常，复视消失，视网膜出血吸收。眼部血管杂音全部消失，术后脑血管造影，瘘口均封闭。结论：对于颈动脉海绵窦瘘应及时治疗，尽快改善眼部淤血状态，以利于视功能恢复。血管内栓塞是目前治疗颈动脉海绵窦瘘最为理想的方法。     

彩色多普勒超声对颈动脉海绵窦瘘的诊断

本文利用彩色多普勒超声技术检测了１３例颈动脉海绵窦瘘患者（颈内动脉海绵窦瘘８例，硬脑膜海绵窦瘘５例）的眼上静脉及双侧颈内动脉的彩色血流显像（ＣＤＦＩ）及脉冲多普勒（ＰＷＤ）频谱，并测定了血流速度及血流量。结果表明：颈动脉海绵窦瘘患者的眼上静脉反向流动，朝向探头，呈红色或红蓝相间；颈内动脉海绵窦瘘患者的眼上静脉的血流速度及血流量均高于硬脑膜海绵窦瘘患者的同类指标，且颈内动脉海绵窦瘘患者患侧颈内动脉的血流速度、血流量均高于健侧的同类指标，而硬脑膜海绵窦瘘的双侧颈内动脉的血流速度及血流量均无明显差异。同时对３例海绵窦栓塞术后患者进行检测，表明眼上静脉及颈内动脉血流动力学恢复正常。由此可以诊断并鉴别诊断颈内动脉海绵窦瘘和硬脑膜海绵窦瘘。与Ｂ超、ＣＴ及ＭＲＩ、ＤＳＡ相比，彩色多普勒超声是一种快速、廉价、无创、无痛的提供二维结构和血流动力学的一种新方法。     

颈动脉海绵窦瘘介入治疗观察

目的探讨颈动脉海绵窦瘘介入治疗效果。方法对8眼(8例)颈动脉海绵窦瘘采用介入治疗并随访分析。结果7例经颈内动脉置入成功。1例经颈内动脉失败后，经眼上静脉置入成功。术后症状逐渐减轻，1～6月随访观察症状体征消失，瘘口消失，血管造影证实颈内动脉通畅，海绵窦不显影。结论颈动脉海绵窦瘘介入治疗安全性高，创伤轻，恢复快，并发症少。是一种较为理想的治疗方法。     

海绵窦型硬脑膜动静脉瘘的眼部表现

目的 探讨海绵窦型硬脑膜动静脉瘘引起眼部改变的特征,提高对该病的认识,减少误诊.设计回顾性分析.研究对象10例经脑血管造影证实的海绵窦型硬脑膜动静脉瘘患者.方法 对患者的病史、眼部表现、临床检查特点及治疗方法进行总结.主要指标眼部及影像学表现.结果 10例患者均有不同程度的球结膜充血和眼球突出,4例患者眼球运动障碍,4例患者出现复视;10例患者均行数字减影脑血管造影检查证实,其可较好地显示窦口的情况.结论 海绵窦型硬脑膜动静脉瘘早期易误诊为眼科疾病,对于突眼、结膜充血、眶压高、疼痛、复视,尤其是伴有颅内血管性杂音的患者应进行脑血管造影检查.(眼科,2008,17:274-277)     

经眼上静脉治疗海绵窦动静脉瘘二例

海绵窦动静脉瘘 ,又称颈动脉海绵窦瘘 (caroridcavernoussi nusfistula)患者因眼部症状就诊眼科时偶而被漏诊或误诊。本文就我科最近接诊的两例海绵窦动静脉瘘患者的诊治进行报告。患者 1,男 ,53岁。因双眼复视 ,左眼球突出 2月 ,于 2 0 0 1年10月 8日入院。入院查体见视力双眼均为 1 0 ,左眼外展受限 ,左眼睑可闻及吹风样杂音 ,球结膜充血 ,屈光间质透明。眼底 :C/D为 0 3 ,视网膜无水肿出血 ,血管无异常改变。右眼未见异常。眼球突出度 :右眼 14mm ,左眼 19mm ,眶距 10 0mm。眼部B超提示左眼静脉血管瘘。眼部MRI检查提示眼上静脉曲张…     

栓塞治疗颈动脉海绵窦瘘的良好效果(英文)

目的:报告外伤后颈动脉海绵窦瘘患者应用螺圈栓塞的成功经验。方法:连续病例。结果:两名颈动脉海绵窦瘘(CCF)患者成功接受了螺圈栓塞治疗。他们分别在机动车事故后2wk和4mo出现CCF的临床症状。一名患者视力良好但眼内压(IOP)升高,另一名则视力低下伴有临界眼内压。CCF的诊断均得到脑血管造影证实,采用螺圈栓塞治疗后两名患者视力恢复正常,在未用任何抗青光眼药物前提下眼压降至正常范围。CCF的症状诸如眼球突出,眼肌麻痹,结膜充血水肿,眼眶杂音及眼底改变也随之消失。结论:颈动脉海绵窦瘘宜早诊断和治疗以避免发生视力丧失严重并发症的发生,血管内栓塞是当代治疗选择。     

栓塞治疗颈动脉海绵窦瘘的良好效果

目的：报告外伤后颈动脉海绵窦瘘患者应用螺圈栓塞的成功经验。 方法：连续病例。 结果：两名颈动脉海绵窦瘘（CCF）患者成功接受了螺圈栓塞治疗。他们分别在机动车事故后2wk和4mo出现CCF的临床症状。一名患者视力良好但眼内压（10P）升高，另一名则视力低下伴有临界眼内压。CCF的诊断均得到脑血管造影证实，采用螺圈栓塞治疗后两名患者视力恢复正常，在未用任何抗青光眼药物前提下眼压降至正常范围。CCF的症状诸如眼球突出，眼肌麻痹，结膜充血水肿，眼眶杂音及眼底改变也随之消失。 结论：颈动脉海绵窦瘘宜早诊断和治疗以避免发生视力丧失严重并发症的发生，血管内栓塞是当代治疗选择。     

彩色多普勒成象在颈动脉海绵窦瘘诊断和监测的应用

报告应用彩色多普勒成象(color Doppler imaging，CDI)对眼眶和颈动脉联台探查评估9例(10只眼)颈动脉海绵窦瘘。患者均经血管造影确诊。CDI检查均发现患眼眼上静脉扩张伴有反向血流及低阻力动脉化频谱。血流动力学定量测定发现：7例颈内动脉海绵窦瘘眼上静脉高血流量，患侧颈内动脉血流量增加和阻力指数下降；2例硬脑膜动脉海绵窦瘘的眼上静脉低血流量，两侧颈内动脉血流动力学无明显改变。还讨论了CDI在颈动脉海绵窦瘘诊断、分类和监测的价值。     

外伤性颈动脉-海绵窦瘘诊断及血管内栓治疗

目的：探讨利用介入神经放射技术对外伤性颈动脉－海绵窦瘘在眼科的诊断和治疗的应用价值。方法：对外伤性颈动脉－海绵窦瘘高度怀疑的病人,利用德国产MULTISTAR PLUS／TOP数字减影血管造影仪,经股动脉插管选择性全脑血管造影,明确诊断及瘘口部位,行血管内可脱性球囊栓塞治疗。结果：眼部及颅内血管杂音消失,眼部充血明显好转,突眼恢复正常,眼球运动功能明显改善,眼底视盘清晰,例一视神经萎缩视力无提高,例二视力无进一步损害。结论：明确的颅脑外伤史,特征性的眼部表现,先进的介入神经放射技术的利用,是眼科诊断和治疗外伤性颈动脉－海绵窦瘘的有效的方法。     

Supraclinoid carotid artery fistula mimicking a carotid-cavernous fistula

Pulsatile exophthalmos syndrome (PES) is characterized by conjunctival injection, orbital bruit, chemosis, exophthalmos, and palpebral edema. It is usually associated with glaucoma, decreased visual acuity, and extrinsic ophthalmoplegia, and mostly secondary to carotid-cavernous fistulas (CCFs), an abnormal communication between the intracavernous segment of the carotid artery and the venous channels in cavernous sinus. We present a case of an abnormal communication between the supraclinoid segment of the carotid artery and the coronary sinus that drains into the contralateral ophthalmic vein simulating a CCF. It was succesfully treated by coil embolization using a percutaneous approach. Other reported rare causes of PES and treatment modalities by embolization are reviewed.     

首诊于眼科的颈动脉海绵窦瘘7例回顾性分析

目的 探讨颈动脉海绵窦瘘眼部表现特点及诊断要点。方法 回顾分析5年中7例首诊于我科的外伤性颈动脉海绵窦瘘者的眼部症状及体征、影像学检查、治疗方法等。所有病例中最常见的眼部表现为搏动性眼球突出、球结膜高度充血水肿、眼压升高等。CT或MRI检查所有病例均显示眼上静脉扩张和海绵窦增宽,数字减影血管造影检查明确诊断。结果 7例行血管内介入栓塞治疗均一次成功,眼部症状和体征得到明显改善。结论 在临床工作中,对于可疑病例,应考虑颈动脉海绵窦瘘的可能,血管造影是该病诊断的金标准,血管内介入栓塞治疗对颈动脉海绵窦瘘是有效的。     

Ocular manifestations and prognosis of secondary glaucoma in patients with carotid-cavernous fistula

PURPOSE: To study the frequency of ocular manifestations and the prognosis of secondary glaucoma in cases of carotid-cavernous fistula (CCF). METHODS: A retrospective multicenter study was conducted to investigate causes, types, ocular symptoms, complications, treatment, and prognosis in subjects with CCF. RESULTS: Among the 43 patients diagnosed with CCF between 1984 and 2000, a total of 13 patients (14 eyes) showed ocular manifestations. CCF was idiopathic in 13 eyes of 12 subjects and resulted from head trauma in 1 eye of 1 subject. Among the ocular symptoms and complications, conjunctival hyperemia was most common, occurring at a rate of 92.9% of the eyes, followed by exophthalmos at 50%, retinal hemorrhaging at 50%, retinal venous dilation at 42.9%, vascular bruits at 28.6%, injection of Schlemm's canal at 21.4%, and external ophthalmoplegia at 21.4%. Elevated intraocular pressure (IOP) occurred at a rate of 64.3%, with maximum IOP ranging from 22-55 mm Hg. At the time of the final observation, IOP control was favorable in 6 of the 9 eyes showing elevated IOP; 5 of these 9 eyes showed a closed CCF, but none required antiglaucoma treatment, with the exception of 1 eye for which trabeculectomy was performed. IOP control was unfavorable in the remaining 3 eyes, and in 1 of these eyes CCF was not closed. CONCLUSIONS: Secondary glaucoma is a frequently observed ocular manifestation of CCF, and closure of the fistula is the primary condition required for favorable IOP control.     

Orbital Compartment Syndrome Following Transvenous Embolization of Carotid-Cavernous Fistula

Abstract

Superior ophthalmic vein (SOV) thrombosis is a rare complication of carotid-cavernous fistula (CCF) embolization and is usually associated with a paradoxical worsening of signs followed by subsequent spontaneous resolution. We report a case in a 69-year-old female who developed orbital compartment syndrome due to SOV thrombosis following transvenous embolization of an indirect CCF. The patient was treated with an urgent lateral canthotomy and cantholysis and had good recovery. This report demonstrates that the paradoxical worsening due to SOV thrombosis in CCF may result in orbital compartment syndrome and require early recognition and prompt decompressive measures to avoid permanent visual sequelae.     

眼上静脉扩张的影像学诊断意义

目的：探讨超声,CT及MRI检查在眼上静脉扩张及其病因诊断中的意义。方法：对1984－2000年临床资料完善的116例（232只眼）伴眼上静脉扩张患者进行回顾性分析。结果：发现多种疾病均可引起眼上静脉扩张,颈动脉－海绵窦瘘是导致眼上静脉扩张的主要疾病。其中颈动脉－海绵窦瘘92例（包括高和低流瘘）,眼型Graves病14例,眶尖炎症2例,Tolosa-Hunt综合征2例,眼部血管畸形2例,眶炎性假瘤、眶内血肿、海绵窦肿瘤及海绵窦血栓形成各1例。扩张的眼上静脉直径为3．5－7．0mm,各病种眼上静脉管径扩张大小无明显差异,但颈动脉－海绵窦瘘眼上静脉最粗7．0mm。影像学检查同时能发现眼外肌肥大、眶部病变及海绵窦膨大等相关影像学表现。结论：超声、CT及MRI检查均能良好显示眼上静脉扩张,综合其他影像学表现,可确定眼上静脉扩张的病因。     

Cataract surgery in a case of carotid cavernous fistula

A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF.     

Bilaterales Hyposphagma

We present the case of an 85-year-old woman who presented with red eyes bilaterally. The right eye had been red for 2 months, and the left one for a shorter time. The ophthalmologic examination showed severely congested episcleral vessels in both eyes, reduction of visual acuity, hyperemia of iris vessels, and pigment epithelium detachment. Ocular tension was within normal range. Both eyes showed impaired ocular movement, and the left eye had an abducens paresis. Our strong suspicion of carotid-cavernous sinus fistula was confirmed through a computed tomographic perfusion study; the previously conducted magnetic resonance examination of the cerebrum was without result.     

改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的临床效果

目的　评价改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的疗效。方法　回顾性分析2017年1月至2018年8月在云南省第二人民医院行改良结膜入路眼眶内下壁减压术治疗的10例（11眼）轻中度甲状腺相关眼病患者。所有患者在术前均给予眼眶水平位、冠状位和矢状位CT检查，测量视力、眼球突出度、复视情况，检查眼外观进行眼前段照相等。将手术前、后眼球突出度，视力以及复视的改善情况作为效果评价指标，对相关数据进行统计和分析。结果　本组11眼术前眼球突出度为（18.94±1.40）mm，术后（15.22±1.46）mm；术后与术前比较，眼球突出度降低（3.72±0.64）mm，差异有统计学意义（t=18.379，P＜0.001）。术前视力为 0.53±0.29，术后为0.62±0.32；术后与术前比较，视力提高0.08±0.10，差异有统计学意义（t=-2.733，P=0.021）。术前复视2例；术后新发生复视2例，均为轻度复视。术前已存在复视的患者，术后复视程度无加重。结论　改良结膜入路眼眶内下壁减压术能有效改善甲状腺相关眼病患者的眼球突出度与视力，术后复视发生概率低，手术切口隐蔽美观，是一种可靠且有效的眶减压术式。     

自发性颈动脉海绵窦瘘眼部表现的临床分析

目的:探讨自发性颈动脉海绵窦瘘眼部表现特点及诊断要点,提高对该病的认识,减少临床漏诊、误诊。方法:回顾分析14例就诊于我院的自发性颈动脉海绵窦瘘患者的眼部症状及体征、影像学检查、治疗方法等。结果:所选14例病例中最常见的眼部表现为眼球突出(100%)、结膜及浅层巩膜充血扩张(93%)。行CT或MRI检查的12例病例中,眼上静脉增粗者9例,海绵窦增宽或高信号者6例。4例行栓塞治疗者眼部症状和体征得到明显改善。结论:自发性颈动脉海绵窦瘘的眼部临床谱广泛多样,特征性眼部表现结合影像学检查可有效提高诊断。栓塞治疗对改善眼部表现效果明显。     

A red eye and then a really red eye

A 90-year-old woman presented with a 4-week history of a presumed infectious conjunctivitis resistant to topical antibiotic medications. Examination revealed tortuous, dilated conjunctival vessels in the right eye, retinal hemorrhages, and an orbital bruit suggestive of a carotid-cavernous sinus fistula (CCF). While awaiting a magnetic resonance imaging study, she returned to the clinic the next day with a painful, swollen right eye and an intraocular pressure of 69 mm Hg. A cerebral arteriogram confirmed a direct CCF. Because of the tortuosity of the systemic vascular anatomy, a right carotid artery cut-down with balloon occlusion was performed with successful closure of the fistula and prompt resolution of the orbital congestion. This case illustrates the spectrum of subtle to conspicuous ocular manifestations that can be seen in patients with CCF and its potential to present as an emergency. CCF should be included in the differential diagnosis of an "atypical" red eye. Recognition of arteriolized conjunctival vessels and auscultation of an orbital bruit raises the possibility of a CCF, requiring prompt diagnostic studies.