颈内动脉海绵窦瘘性突眼

王×　男　2 7岁　因右眼突出伴耳鸣10余天于2 0 0 2年10月12日入院。否认外伤史及其它疾病史。全身体格检查,生命体征及颈、胸、腹、四肢等均正常。右眼视力0 8,左眼1 0。右眼睑启闭自如,颞侧球结膜见一粗大纡曲紫红色血管,角膜、前房、虹膜均正常。瞳孔3×3mm ,直、间接对光反应存在。晶状体、玻璃体透明。眼底正常。右眼突出度2 0mm ,左眼突出度14mm。眼球外转明显受限,上、下、内转轻度受限。低头试验右眼阳性,听诊器于右眼眶上缘及右额部、耳后可闻及较弱风吹样与脉搏搏动一致的血管杂音。左眼正常。三维CT :三维图像冠状位动脉期见…     

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     

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。     

外伤性颈动脉海绵窦瘘致搏动性眼球突出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,搏动性突眼立即或逐渐消失。结论微弹簧圈栓塞是治疗TCCF致搏动性突眼的有效方法。     

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。     

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.     

颈动脉-海绵窦血管瘘致突眼二例

颈动脉-海绵窦血管瘘是一种较为少见的神经眼科综合征，80％以上的患者首发眼部症状和体征，而就诊于眼科，易误诊误治。我科在2003年9月～2003年10月间先后收治2例因颈动脉-海绵窦血管瘘而致突眼的患者。报告如下。     

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。     

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。     

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。     

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.     

The use of Digital Subtraction Angiography in The Evaluation of Carotid Cavernous Sinus Fistulas

Intravenous digital subtraction angiography (IV-DSA) is a safe, rapid procedure that can be performed on an outpatient basis and provide diagnostic information comparable to conventional angiography. This paper reviews the initial experience with intravenous digital subtraction angiography in the evaluation of five cases of carotid cavernous sinus fistulas. An illustrated example will be presented.     

Optical Coherence Tomography Characterization of Macular Changes Secondary to Arteriovenous Fistula

Arteriovenous fistulas (AVFs) are abnormal shunts between the arterial and venous vascular systems. These usually produce ocular pain, increased intraocular pressure (IOP), and diplopia. Less frequently, they may cause retinal changes with visual impairment. Our purpose is to illustrate different retinal manifestations of AVF. We report the multimodal imaging study of three cases with retinal changes due to AVF, showing neurosensory retinal detachment, macular oedema, and macular ischemia. In conclusion, AVF may appear with different ophthalmic alterations. While usually increased IOP and diplopia are our main concerns, retinal study is mandatory, since a myriad of morphologic abnormalities might be present.     

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.     

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。     

眼眶瘘管的特点及治疗分析

目的 探讨不同病因眼眶瘘管的特点及治疗方法.方法 回顾性分析1980年1月至2007年7月就诊的眼眶瘘管患者37例.结果 37例中异物引发的21例.眼眶囊肿引发的9例.眼眶感染性炎症引发的6例.嗜酸性肉芽肿1例,如瘘管可排出脓液、豆渣样物及澄清液体,分别提示感染性炎症、皮样囊肿及非感染性因素.结论 眼眶瘘管形成的常见原因是异物存留、皮样囊肿(包括表皮样囊肿)和骨髓炎.     

Direct Orbital Puncture of the Cavernous Sinus for the Treatment of a Carotid-Cavernous Dural AV Fistula with a Concomitant Venous/Lymphatic Malformation

Abstract

A 37- year old male with a long history of a left orbital venous/lympathic malformation presented with ocular injection, increased proptosis and reduced left vision. Angiography demonstrated a carotid cavernous dural AV fistula combined with a concomitant venous/lymphatic malformation. After attempts at transvenous embolization, a direct uncomplicated transorbital puncture of the cavernous sinus via a lateral orbitotomy was performed with complete resolution of ocular symptoms.