经颅多普勒对颈动脉海绵窦瘘检测及疗效评估的研究

目的 评价经颅多普勒（TCD）对颈动脉海绵窦瘘检测及疗效评估的应用价值。方法 采用TCD对113例颈动脉海绵窦瘘进行探测，观察其血流动力学变化特征，术后复查，评估疗效，所有病例均有数字减影脑血管造影（DSA）对照。结果 TCD探测显示颈内动脉瘘口近端流异常增高，阻力降低，而远端大脑中动脉、大脑前动脉流速降低，尤其以大脑前动脉明显；异常眼上静脉频谱及患侧颈内动脉末端倒灌血流为颈内动脉海绵窦瘘的特征性表现；TCD与DSA比较发现，DSA显示瘘口越大，TCD检测例灌血流越明显。结论 TCD是颈动脉海绵窦瘘诊断、鉴别诊断、疗效评估及随访的一种无创、准确、可重复的检测手段。

Comparison between transcranial Doppler and digital subtractive angiography for detection of carotid-cavernous fistulas and evaluation of curative effect on them

Objective To evaluate the value of transcranial Doppler (TCD) in detecting the carotid cavernous fistulas (CCFs) and assessing the curative effect on them.Methods The features of hemodynamic changes were observed in 113 patients with CCFs who were examinated by TCD before and after the operation.The data obtained by TCD were compared with those by digital subtractive angiography (DSA).Results TCD showed that the velocity of blood flow in the proximal internal carotid artery (ICA) of the fistula orifice was abnormally high and its resistance was low.But the velocities of blood flow in the distal ICA of the fistula orifice,such as the middle cerebral artery and anterior cerebral artery,were reduced in the patients with CCFs.The abnormal frequency spectrum in the superior ophthalmic vein and reflux of blood in the ICA ipsilateral to CCF were the characteristic manifestations of CCF.The larger the CCF orifice showed on DSA was,the more obvious the reflux of blood in the ICA ipsilateral to CCF on TCD was.Conclusions TCD is a noninvasive,accurate and repeatable examination method for the diagnosis,differetial diagnosis,curative effect evaluation and follow up of CCF.