经颅多普勒超声在外伤性颈内动脉海绵窦瘘诊断中的价值

目的 探讨经颅多普勒超声(TCD)检测脑血流对外伤性颈内动脉海绵窦瘘的诊断、治疗和术中监测的价值。方法 使用TCD检测25例有颅内杂音、突眼及其他存在海绵窦瘘的高危原因的颅脑外伤患者，所有病例均经数字减影血管造影(DSA)明确诊断。栓塞术中TCD监测评价脑血流状态的变化和栓塞的效果，并与DSA检查结果对照。用DSA检查未见脑血管异常的18例患者的TCD资料为对照。结果 TCD检测发现颈内动脉颅外段的高流速低阻力频谱，大脑中、前动脉的低流速低阻力频谱以及眼上静脉异常频谱为颈内动脉海绵窦瘘的特征性改变，具有较高的准确性和特异性。术中TCD监测可实时准确地评估栓塞是否成功。结论 TCD检测是诊断颈内动脉海绵窦瘘、指导治疗、术中监测、疗效评估和随访的有效手段，具有无创、准确和可重复的优点。

Diagnostic value of transcranial Doppler detecting for traumatic carotid cavernous fistula

Objective To explore the value of transcranial Doppler(TCD) in diagnosis, treatment and monitoring for operation of traumatic carotid-cavernous fistula(TCCF). Methods Preliminary assessment TCCF in 25 patients by TCD and following final diagnosis by digital subtraction angiography(DSA).The features of hemodynamic changes were monitored during endovascular embolization treatment by TCD and compared with those by DSA. The data obtained by TCD subjects with normal DSA findings in 18 were referenced.Results TCD showed that the higher mean velocity of blood flow and the lower pulsatility index(PI) in extra-cranium portion of the carotid-cavernous.But the mean velocities of blood flow(Vm) and PI were reduced in the middle cerebral artery(MCA) and anterior cerebral artery(ACA).The abnormal frequency spectra in superior ophthalmic vein was found.These were the characteristic manifestations of TCCF and with higher accuracy and specificity.Monitoring during operation by TCD may reflect accurately the features of hemodynamic changes while achieving successful operation. Conclusions TCD is an effective examination method for the diagnosis, guidance-therapy, therapeutic effect evaluation, follow-up and monitoring of TCCF during the operation,with noninvasive, accurate and repeatable specialities.