以突眼为表现的眼部血管病——颈动脉海绵窦瘘的介入治疗

目的探讨颈动脉海绵窦瘘眼部表现特点、影像学检查及介入治疗方法。 方法回顾分析5年中18例首诊于我院眼科的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。18例患者均行介入手术治疗，其中应用可解脱球囊封堵瘘口12例，应用弹簧圈+Onyx胶封堵瘘口3例，覆膜支架隔绝瘘口3例。 结果所有病例中最常见的眼部表现为搏动性眼球突出、球结膜充血水肿、眼球运动障碍等。头颅或眼部CT平扫检查所有病例均显示患侧眼球突出，眼上静脉增粗；全部患者均行数字减影血管造影检查明确诊断。本组18例（20眼）均行介入手术治疗，其中应用可解脱球囊封堵瘘口12例（14眼），结果10例（12眼）瘘口完全闭塞，发生并发症2例，无严重并发症或死亡病例。应用弹簧圈+Onyx胶封堵瘘口3例（3眼）、覆膜支架隔绝瘘口3例（3眼），瘘口均完全闭塞，无并发症或死亡病例。全部手术患者眼部症状和体征均得到明显改善。随访时间（12±3.4）个月，无复发病例，颈动脉覆膜支架内未发生狭窄及闭塞。 结论对于以突眼及其他相关症状就诊于眼科的患者，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，介入手术治疗对颈动脉海绵窦瘘是安全有效的。

Interventional treatment of carotid cavernous fistula with ocular vascular disease manifested by exophthalmos

ObjectiveTo explore the ocular manifestations, imaging examination and interventional treatment of carotid cavernous fistula. MethodsRetrospective analysis of the ocular symptoms and signs, imaging examinations, and treatment methods of 18 cases of carotid cavernous fistula who were first diagnosed in our hospital in 5 years was performed. All 18 patients underwent interventional treatment. Among them, 12 cases were sealed with detachable balloons, 3 cases were sealed with coils and Onyx, and 3 cases were covered with stent graft. ResultsThe most common ocular manifestations in all cases were pulsatile eyeball protrusion, conjunctival congestion and edema, and eye movement disorders. All CT scans of the head or eyes showed that the eyeballs were protruded and the superior ocular veins were enlarged; all patients underwent digital subtraction angiography to confirm the diagnosis. All 18 cases (20 eyes) in this group underwent interventional treatment. Among them, 12 cases (14 eyes) were sealed with a detachable balloons to seal the fistula. As a result, 10 cases (12 eyes) were completely occluded, and 2 cases had complications, There were no serious complications or deaths. 3 cases(3 eyes) of fistula were sealed with coils & Onyx , and 3 cases (3 eyes) were isolated with stent graft. The fistula was completely occluded without complications or deaths. The ocular symptoms and signs of all patients were significantly improved. During the follow-up period (12±3.4 months), there was no recurrence, and no stenosis and occlusion occurred in the carotid stent graft. ConclusionsFor patients with exophthalmos and other related symptoms in ophthalmology, the possibility of carotid cavernous fistula should be considered. Angiography is the gold standard for the diagnosis of the disease. Interventional treatment is safe and effective for carotid cavernous fistula