首诊眼科的外伤性动静脉海绵窦瘘分析

目的探讨外伤性动静脉海绵窦瘘(TCCF)患者的眼科临床特点、影像学检查特点及其诊断与治疗。方法回顾性分析5例首诊眼科的TCCF患者的临床资料。结果 5例TCCF经血管内介入治疗后,症状体征均消退,瘘口消失。结论 DSA检查及血管内栓塞技术是较理想的诊断及治疗方法,超声、CT、MRI等影像学检查对 TCCF的诊断各有所长,可作为辅助手段。     

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。     

外伤性颈内动脉海绵窦瘘8例分析

目的探讨外伤性颈内动脉海绵窦瘘(TCCF)的临床特点及血管内栓塞治疗的价值与效果。方法回顾性地分析8例外伤性颈内动脉海绵窦瘘患者的眼部表现、影像学特点及血管内栓塞治疗情况。结果8例患者均诊断正确。8例TCCF通过DSA技术,采用可脱性球囊行血管内栓塞治疗,7例成功(成功率87.5%),1例采用弹簧圈堵塞近瘘口处血管。治疗后全部病例均获成功,临床症状和体征消失,无1例复发。结论特征性眼部表现及超声、CT、MRI可确诊TCCF,DSA检查及血管内栓塞技术是目前TCCF最理想的诊断和治疗方法。     

颈内动脉海绵窦瘘的眼部表现及介入治疗

目的探讨颈内动脉海绵窦瘘（CCF）的眼科诊断和介入治疗。方法回顾性分析6例CCF的临床表现和诊断,以及应用可脱性球囊及GDC弹簧圈栓塞治疗的临床资料。结果6例CCF的瘘口完全闭塞,临床症状消失。结论CCF治疗的关键在于及时的诊断以及闭塞瘘口。     

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。     

硬脑膜海绵窦瘘的眼部表现三例

硬脑膜海绵窦瘘（dural cavernous fistula,DCF）又称为硬脑膜分流综合征（dural shunt syndrome,DSS）、硬脑膜海绵窦动静脉短路（dural cavernous arteriovenous shunts,DCAVS）、硬脑膜动静脉瘘（dural arteriovenous fistula,DAVF）、红眼短路综合征等,是由于颈内、外和（或）椎基底动脉的硬脑膜枝与海绵窦发生直接或间接交通所引起的一组神经眼科综合征.由于其多为自发、瘘口小、流量低、发病偶然,患者早期常无明显的自觉症状,直到产生并发症或晚期症状加重才被诊断.     

外伤性颈内动脉—海绵瘘的DSA血管内治疗

目的：探讨数字减影血管造影（Digital subtraction angiography,DSA)及血管内治疗对外伤性颈内动脉-海绵瘘（Traumatic carotid-cavernous fistula,TCCF)的诊断及治疗价值。方法：对9例以搏动性突眼为主要症状的海绵窦瘘患者行DSA检查及行可脱性球囊血管内栓塞治疗总结分析。结果：9例患者均成功栓塞瘘口且保留载瘤动脉通畅。结论：DSA检查和血管内栓塞治疗是TCCF理想的诊断与治疗方法。     

颈动脉海绵窦瘘的影像学诊断及血管内栓塞治疗

目的 评价颈动脉海绵窦瘘(CCF)应用影像学诊断及血管内栓塞治疗的价值。方法 分析23例颈动脉海绵窦瘘患者的眼部表现、影像特点。进行血管内栓塞治疗。结果 全部病例最终获正确诊断。19例行血管内栓塞术者，16例1次成功，2例行2次栓塞成功，1例失败。术后视力除3例术前失明未恢复外，16例较术前提高。眼部及颅内有关症状和体征全部消失或明显改善。结论 特征性眼部表现。超声、CT、选择性全脑数字减影血管造影(DSA)是诊断CCF的有效方法。血管内栓塞技术是目前CCF治疗的最理想方法。     

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。     

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)     

Dural arteriovenous fistula of the sigmoid sinus with a clinical expression on the opposite eye: A case report

We report the case of an 87-year-old patient who developed a dural arteriovenous fistula of the sigmoid sinus with progressive exophthalmia in the opposite eye. The patient had a unilateral decrease in visual acuity; the vessels of the conjunctiva were dilated, and a progressive central retinal vein occlusion occurred in the left eye. A dural carotid cavernous fistula of the right sigmoid sinus was diagnosed with an angiography exam and was successfully treated with embolization of the arteriovenous shunt using Onyx(?). A central partial facial nerve paralysis occurred after embolization and spontaneously resolved in 6 months. Six months after the treatment, visual acuity improved to 7/10 and the exophthalmia and central retinal vein occlusion signs regressed. Dural arteriovenous fistulae are abnormal shunts between a collateral vessel of the carotid artery and the cavernous sinus; the unilateral pulsating exophthalmia is the most frequent associated symptom. Cerebral MRI is useful to analyze indirect signs of the arteriovenous shunt showing an abnormal dilatation of the veins, but angiography of the carotid artery is essential to confirm the diagnosis. Furthermore, it allows treatment of the fistula at the same time, the main complication being the embolization of normal vessels close to the abnormal shunt. The clinical expression of the dural arteriovenous fistula on the opposite eye is infrequent and is related to the presence of complex septae within the cavernous sinus, resulting in a bilateral drainage of the cerebral venous system. The early diagnosis and management of the disease is necessary to improve the visual prognosis.     

Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein

BACKGROUND: Treatment of choice for symptomatic carotid-cavernous and cavernous-dural fistulas is neuroradiologic intervention via the femoral artery. Owing to the location of the fistula and/or to anatomic variations, a direct surgical approach via the superior ophthalmic vein may be necessary for embolization. METHODS: Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement, and secondary glaucoma. One patient had visual impairment and scotoma due to compression of the optic nerve by the fistula. The tentative diagnosis of an arteriovenous fistula was confirmed in two cases by color Doppler imaging and in all three cases with cerebral arterial angiography (two carotid-cavernous fistulas, one cavernous-dural fistula). After an unsuccessful transarterial attempt, embolization via the superior ophthalmic vein was chosen. RESULTS: In all three patients the preparation of the superior ophthalmic vein was performed without any complications. In two cases the fistula could be embolized completely with platinum coils. In one patient the placement of the microcatheter was impossible, because of an abnormal vascular pattern. Later on the fistula was successfully embolized by an approach via the femoral vein. All three patients had complete resolution of symptoms. There were no recurrences. CONCLUSION: Embolization of carotid-cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein represents safe and effective treatment when standard transarterial access is impossible. The cooperation of an orbital surgeon and an invasive neuroradiologist can be of benefit for this rare group of patients.     

Uncontrolled glaucoma secondary to an arteriovenous malformation in a Weill-Marchesani patient.

BACKGROUND: Weill-Marchesani syndrome is a rare condition with ocular and systemic manifestations. Common ocular signs are microspherophakia, ectopia lentis, and secondary glaucoma. The glaucoma is usually treatable through medical or surgical management. The most-common arteriovenous malformation (AVM) with ocular effects is the carotid-cavernous sinus fistula. It is very uncommon to observe ocular complications from an AVM in the area of the straight sinus and vein of Galen. AVMs in any location are unusual with Weill-Marchesani syndrome. CASE REPORT: We present a case of severe asymmetric glaucoma in a Weill-Marchesani patient with an AVM in the area of the straight sinus and vein of Galen. The patient demonstrates the known clinical signs of Weill-Marchesani syndrome: short stature, microspherophakia, lens subluxation, and secondary glaucoma. An AVM is diagnosed with corresponding monocular proptosis and asymmetric glaucoma. The patient's serious systemic health problems and the location of the AVM make treatment difficult. CONCLUSION: This case documents the very unusual occurrence of unresponsive glaucoma secondary to an AVM not located in the cavernous sinus. The Weill-Marchesani syndrome may be partially responsible for the glaucoma. Patients with Weill-Marchesani syndrome require early diagnosis in order to treat serious ocular and life-threatening systemic complications.     

原发性闭角型青光眼临床分型的探讨

目的 探讨将原发性闭角型青光眼分为原发性急性闭角型青光眼和原发性慢性闭角型青光眼这种分型方法的可行性和科学性。方法 按原发性闭角型青当眼的诊断标准。将325例325眼原发性闭角型青光眼眼的住院患者按有否急性发作的症状和发作后存在的相应体征进行分类统计。结果 325眼原发性闭角型青光眼中,有急性发作症状和体征的89眼,占27.4%;有发作的症状但缺乏发作后的体征者78眼,占24%;无存在任何发作症状和发作后的相应体证者20眼。占6.2%;无法归类者138眼,占42.4%。结论 将原发性闭角型青光眼根据是否存在急性发作的症状和发作后存在的相应体征作为划分急闭和慢闭的标准是不够科学的,这种分类对指导临床的防治工作无实际意义。     

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。     

Surgical transvenous embolization of spontaneous carotid cavernous sinus fistulas in two patients

BACKGROUND: Arteriovenous communications in which blood flows from meningeal branches of the internal and external carotid arteries into the venous circulation around and in the cavernous sinus are termed spontaneous (dural) carotid sinus cavernous fistulas. Due to their mostly low shunt volume they are rarely life threatening, but without treatment they may cause severe ocular complications like episcleral secondary glaucoma, central vein occlusion or exudative retinal detachment. Traditional therapy is the transarterial approach by an interventional neuroradiologist. If such an approach is not possible or unsuccessful a transvenous route has to be considered. PATIENTS AND METHODS: Two patients underwent anterior orbitotomy via sub brow incision or infraciliary incision with cannulation of the superior ophthalmic vein or the inferior ophthalmic vein and embolization of the cavernous sinus with platinum coils. RESULTS: Successful closure was achieved on angiography and normalisation of clinical symptoms after a short period of progressive venous congestion. CONCLUSIONS: For arteriovenous fistulas that cannot be embolized arterially the surgical transvenous orbital route may work as a method of second choice. When performed by an interdisciplinary team (orbital surgeon, interventionell neuroradiologist) it is a technically straightforward, effective and promising approach.     

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。     

Ophthalmologic outcome of transvenous embolization of spontaneous carotid-cavernous fistulas: a preliminary report

We give a preliminary report of theophthalmologic outcome offour patients with transvenousembolization studied for their spontaneouscarotid-cavernous fistulas. One ofthem is a direct type while threeof them are indirect dural shunts. Inindirect dural shunts, traditionaltransarterial embolization rarelyachieves a complete clinical cure in ashort period of time. All caseshad an ophthalmologic disturbancejustified for endovascularintervention. We performed catheterization,and subsequently embolization withGuglielmi Detachable coils, tothe cavernous sinus via the femoralvein and inferior petrosal sinus/superiorophthalmic vein. All fourpatients achieved clinical andangiographic improvement with afollow-up period range from twoto sixteen months except for onepatient who had residual bilateralsixth nerve palsy. The transvenousapproach offers an effective andsafe alternative for the management ofspontaneous carotid-cavernous fistula.     

Treatment of carotid cavernous fistulas

The diagnosis and treatment of carotid cavernous fistulas (CCF) is an interdisciplinary challenge for both ophthalmologists and interventional neuroradiologists. According to the clinical signs and symptoms the tentative diagnosis is made by the ophthalmologist. It is the task of the neuroradiologist to ascertain this diagnosis by intra-arterial angiography. If a fistula is suspected this invasive diagnostic procedure is indispensable, not only to establish the diagnosis but also to classify those types of fistula with an unfavourable spontaneous course possibly resulting in intracranial haemorrhage. The indication for therapy is based on the clinical symptoms and the angiographic findings. In a number of cases no therapy is required. Since a fistula may change over time, these patients have to be under close ophthalmological surveillance. In many patients a conservative therapeutic approach with manual compression of the carotid artery is sufficient as a fIrst step. Invasive treatment is performed via the endovascular approach in almost all cases. Direct CCF are predominantly treated transarterially with detachable balloons and/or coils. Recently, intracranial stents have been used increasingly. The embolisation of indirect CCF is most effective using the transvenous access with coils. There are several approaches to the cavernous sinus. The interventional occlusion of CCF is nowadays a very effective treatment associated with a comparatively high cure rate and low incidence of complications. By close cooperation between ophthalmologists and neuroradiologists the patients can be protected against visual loss, the development of a secondary glaucoma, and, most importantly, against intracranial haemorrhage.