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。

Intravascular occlusion and clinical manifestation for eyes of carotid cavernous fistula

Objective　To evaluate the effect of intravascular occlusion for carotid cavernous fistula (CCF) by analying the clinical features of CCF. Methods　Twelve cases with CCF were analysed on their medical histories, clinical features in the eyes, clinical examinations and the therapeutic effects of balloon occlusion in internal carotid artery.Results　Ten cases were treated successfully(83.33%), in which 2 cases were treated once more. There was no operation complication. The visual acuity of one case increased from no light perception to finger movement within 1 week preoperatively. The visual acuity of 10 cases improved 1～4 lines (Snellen chart). Some clinical symptoms and signs such as the lid, conjunctiva swelling, diplopia, the movement of eyeball and retinal hemorrhage were decreased remarkably. Carotid fistula of 12 cases with CCF were found to be occlusioned by digital subtraction angiography after operations.Conclusion　The early diagnosis and treatment for CCF are necessary. Color doppler flow imaging, CT and DSA are useful examination methods for diagnosis of CCF. Intravascular occlusion is the best therapeutic method for CCF nowadays.