外伤性颈动脉海绵窦瘘致搏动性眼球窝出24例的治疗体会

目的 探讨创伤性ＴＣＣＦ所致搏动性眼球突出最佳治疗方法。方法 分别采用开颅行颈部颈内动脉结扎和颅内动脉结扎；开颅行海绵窦内铜丝堵塞瘘口术；用介入治疗方法行微弹簧圈ＴＣＣＦ栓塞术。结果 颈内动脉，海绵窦瘘孤立手术２例治愈，但术后眼球回缩迟缓。铜丝血栓凝固术２例，术后出现严重头痛月余。微弹簧圈栓塞２０例，搏动性突眼或逐渐消失。结论 微弹簧圈栓塞是治疗ＴＣＣＦ致搏动性突眼的有效方法。     

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。     

微弹簧圈栓塞术治疗外伤性颈内动脉海绵窦瘘的临床研究

目的 探讨微弹簧圈栓塞术治疗外伤性颈内动脉海绵窦瘘(TCCF)的临床效果.方法 回顾性分析15例(15只眼)TCCF病例,采用计算机体层摄影术(CT)、核磁共振成像(MRI)和数字减影血管造影(DSA)明确诊断,应用微弹簧圈栓塞术进行治疗.对术前和术后眼部改变进行评价.结果 术前所有病例均有程度不同的眼球突出,13只眼(86.7%)有眼外肌麻痹,11只眼(73.3%)出现视乳头充血,14只眼(93.3%)出现高眼压,11只眼(73.7%)有不同程度的视力下降.15例(15只眼)全部1次栓塞治疗成功,无并发症发生.所有患眼病情得到明显缓解,视力均在0.5以上.结论 微弹簧圈栓塞术是一种治疗TCCF安全、有效的方法.     

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。     

经眼上静脉栓塞治疗难治性颈内动脉海绵窦瘘的短期疗效观察

目的 探讨经眼上静脉栓塞治疗难治性颈内动脉海绵窦瘘的临床疗效.设计回顾性病例系列.研究对象11例经全脑血管数字减影确诊的颈内动脉海绵窦瘘患者,均为传统动脉入路治疗失败或复发者.方法 所有患者均行经眼上静脉微弹簧圈或液体胶栓塞治疗.主要指标视力、眼球突出度、眼球运动、复视、结膜充血、眼底改变.结果 随访1周～3个月,11例患者均临床治愈.6例患者突眼消失,5例改善;8例结膜充血消失,3例减轻;3例视力下降患者中,1例恢复正常,2例提高;颅内杂音及复视全部消失,眼球运动恢复正常.结论 多学科合作经眼上静脉栓塞介入治疗难治性颈内动脉海绵窦瘘是一种安全、有效的治疗方法.     

外伤性搏动性眼球突出的可脱性球囊栓塞手术

目的 探讨外伤性搏动性眼球突出(颈动脉海绵窦瘘)使用可脱性球囊介入手术栓塞治疗的方法、结果和技术特点。方法 分析应用可脱性球囊栓塞治疗的外伤性颈动脉海绵窦瘘19例，数字影像监测下采用可脱性球囊闭塞瘘口或闭塞患侧颈内动脉。结果 19例中，15例(78．9％)保持了颈内动脉通肠、4例(21．1％)闭塞了颈内动脉，术后临床症状逐渐消失：结论 应用可脱性球囊栓塞治疗外伤性颈动脉海绵窦瘘是目前最理想的治疗方法，具有手术创伤小、安全性高和疗效可靠等优点。     

数字减影脑血管造影对海绵窦瘘的诊断及其血管内治疗

目的 探讨全脑动脉数字减影血管造影（ｄｉｇｉｔａｌｓｕｂｔｒａｃｔｉｏｎａｎｇｉｏｇｒａｐｈｙ,ＤＳＡ）血管内治疗,对以搏动性眼球突出为主要表现的颈动脉海绵窦瘘（ｃａｒｏｔｉｄｃａｖｅｍｏｕｓｓｉｎｕｓｆｉｓｔｕｌａ,ＣＣＦ）的诊断及治疗价值。方法 对１５例海绵窦瘘患者行ＤＳＡ,１２例行可脱性球囊,微螺圈血管内栓塞治疗。结果 １５例中,１２例为高流量单侧颈内动脉型ＣＣＦ,３例为低流量单侧颈外动脉     

颈内动脉海绵窦瘘眼部表现

颈内动脉海绵窦瘘（carotid-cavernous fistula，CCF）临床表现多体现在眼部，主要有搏动性突眼、眼球运动障碍伴球结膜充血、水肿。故常首诊于眼科。如何早期诊断，及时治疗对我们眼科医生提出了挑战。     

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。     

Reversible optic neuropathy due to carotid-cavernous fistula

Optic nerve dysfunction occurred several weeks after traumatic carotid-cavernous fistula developed in a 21-year-old man. Vision was completely restored after the fistula was closed with an intra-arterial detachable balloon. By carefully monitoring visual function in patients with traumatic carotid-cavernous fistulas, delayed optic neuropathy can be recognized and treated successfully.     

颈动脉一海绵窦瘘

目的：探讨31例TCCF及5例SCCF的临床特点与疗效。方法：回顾性地分析该病的诊断和治疗方法。结果：24例TCCF经血管内栓塞治疗后有22例。症状及体征消退，瘘口消失(治愈率91．7％)。好转2例(8．3％)，症状和体征减轻，瘘口基本闭塞。5例SCCF经保守治疗。效果良好。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。     

Angioarchitectural Evolution of Clival Dural Arteriovenous Fistulas in Two Patients

Dural arteriovenous fistulas (dAVFs) may present in a variety of ways, including as carotid-cavernous sinus fistulas. The ophthalmologic sequelae of carotid-cavernous sinus fistulas are known and recognizable, but less commonly seen is the rare clival fistula. Clival dAVFs may have a variety of potential anatomical configurations but are defined by the involvement of the venous plexus just overlying the bony clivus. Here we present two cases of clival dAVFs that most likely evolved from carotid-cavernous sinus fistulas.Key Words: Neuro-ophthalmology, Carotid-cavernous sinus fistula, Clivus, Clival fistula, Dural arteriovenous fistula     

Late-Onset Abducens Nerve Palsy after Endovascular Treatment for Carotid-Cavernous Fistula: Two Case Reports

Endovascular treatment, including transarterial embolisation and transvenous embolisation, is generally considered effective for treating carotid-cavernous fistula. Immediate cranial nerve palsy following the procedure is the most common complication, but it usually resolves spontaneously. The authors report two cases of late-onset abducens nerve palsy after successful obliteration of direct carotid-cavernous fistulas, both of which required strabismus surgery.     

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.     

Abstracts of the 2010 Meeting of the International Neuro-Ophthalmology Society,Lyon, France

Abstract

Endovascular treatment, including transarterial embolisation and transvenous embolisation, is generally considered effective for treating carotid-cavernous fistula. Immediate cranial nerve palsy following the procedure is the most common complication, but it usually resolves spontaneously. The authors report two cases of late-onset abducens nerve palsy after successful obliteration of direct carotid-cavernous fistulas, both of which required strabismus surgery.     

Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.Key Words: Exophthalmos, Papilledema, Carotid artery injury, Carotid cavernous sinus fistula, Endovascular procedure, Therapeutic embolization     

Carotid-cavernous and orbital arteriovenous fistulas: ocular features,diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

The author investigated 101 cases with direct dural carotid-cavernous and orbital arteriovenous fistulas (CCF). The characteristic clinical findings, such as specific epibulbar arterialized loops, are described and the differential diagnosis of the striking diagnostic triad (exophthalmos, the above-mentioned loops and glaucoma) is discussed, together with the exclusion criteria for other causes of red eyes, episcleral measurements and blood flow. The results of various diagnostic procedures, such as ultrasonography, Doppler hematotachography and color Doppler of the orbit and carotid systems, magnetic resonance imaging and angiography, and of conservative treatment and embolization processes are dealt with successively. The classification of different types of carotid-cavernous fistulas is presented,(1-3) together with the clinical signs in relation to morbidity and mortality during or after conservative or intervention therapies. The importance of patient follow-up, in the clinic as well as with Doppler methods, is emphasized in order to differentiate a progressive or diminished clinical condition caused by spontaneous thrombosis in the healing process or more arteriovenous flow. A 'decision tree' for use in daily practice is provided. In this study, of the 101 cases in which the localization was diagnosed by angiography, 42 were direct (30 traumatic, 12 spontaneous), 31 were dural (3 traumatic, 28 spontaneous) and 10 were orbital CCFs. In 18 other cases, usually dural or orbital shunts, angiography was not performed. For the management of 42 direct fistulas, conservative treatment was used in 12 cases (7 with success; 58%) and balloon embolization was performed in 18 cases (17 with success; 94.5%); the other cases were treated by direct or indirect surgery. Of the 48 (spontaneous and traumatic) dural fistulas, 39 were treated conservatively (32 recovered or were much improved: 82%, of the total cases, 67%). All seven cases in which embolization was performed were cured and/or much improved. In two cases, one fistula was conservatively treated while one was embolized at another location, both with success. Of the 10 orbital arteriovenous shunts showing signs of dural fistulas, the features disappeared in 8 cases, although after a much longer follow-up period than for the typical dural carotid-cavernous sinus fistulas; in one patient, direct surgery was performed successfully and in one patient the original, non-progressive, orbital features could still be observed.     

Carotid-cavernous and orbital arteriovenous fistulas: ocular features,diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

The author investigated 101 cases with direct dural carotid-cavernous and orbital arteriovenous fistulas (CCF). The characteristic clinical findings, such as specific epibulbar arterialized loops, are described and the differential diagnosis of the striking diagnostic triad (exophthalmos, the above-mentioned loops and glaucoma) is discussed, together with the exclusion criteria for other causes of red eyes, episcleral measurements and blood flow. The results of various diagnostic procedures, such as ultrasonography, Doppler hematotachography and color Doppler of the orbit and carotid systems, magnetic resonance imaging and angiography, and of conservative treatment and embolization processes are dealt with successively.The classification of different types of carotid-cavernous fistulas is presented, together with the clinical signs in relation to morbidity and mortality during or after conservative or intervention therapies.The importance of patient follow-up, in the clinic as well as with Doppler methods, is emphasized in order to differentiate a progressive or diminished clinical condition caused by spontaneous thrombosis in the healing process or more arteriovenous flow. A ‘decision tree’ for use in daily practice is provided. In this study, of the 101 cases in which the localization was diagnosed by angiography, 42 were direct (30 traumatic, 12 spontaneous), 31 were dural (3 traumatic, 28 spontaneous) and 10 were orbital CCFs. In 18 other cases, usually dural or orbital shunts, angiography was not performed. For the management of 42 direct fistulas, conservative treatment was used in 12 cases (7 with success; 58%) and balloon embolization was performed in 18 cases (17 with success; 94.5%); the other cases were treated by direct or indirect surgery. Of the 48 (spontaneous and traumatic) dural fistulas, 39 were treated conservatively (32 recovered or were much improved: 82%, of the total cases, 67%). All seven cases in which embolization was performed were cured and/or much improved. In two cases, one fistula was conservatively treated while one was embolized at another location, both with success. Of the 10 orbital arteriovenous shunts showing signs of dural fistulas, the features disappeared in 8 cases, although after a much longer follow-up period than for the typical dural carotid-cavernous sinus fistulas; in one patient, direct surgery was performed successfully and in one patient the original, non-progressive, orbital features could still be observed.     

Spontaneous dural carotid-cavernous fistula with central retinal vein occlusion and iris neovascularization.

Spontaneous dural carotid-cavernous fistulas are dural vascular malformations that usually run a benign course. We present a case of a spontaneously occurring dural carotid-cavernous fistula complicated by central retinal vein occlusion and iris neovascularization that led to progressive visual failure.