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海绵窦区硬脑膜动静脉瘘的临床观察分析
引用本文:杨文芝,吴强,杜新华,宋蓓雯.海绵窦区硬脑膜动静脉瘘的临床观察分析[J].中国实用眼科杂志,2009,27(11).
作者姓名:杨文芝  吴强  杜新华  宋蓓雯
作者单位:上海交通大学附属第六人民医院眼科,上海,200233
摘    要:目的 探讨海绵窦区硬脑膜动静脉瘘的I临床表现及诊断要点.并观察其治疗结果.方法 回顾分析6例海绵窦区硬脑膜动静脉瘘患者的lf缶床症状及体征、影像学检查、治疗方法及随访结果.结果 4例患者行瘘口栓塞术,其中3例瘘口闭塞,症状及体征明显好转,视力恢复,眼压保持正常范围;1例瘘口未完全闭塞,继发新生血管性青光眼.2例患者未行瘘口栓塞术.结论 海绵窦区硬脑膜动静脉瘘患者早期眼部的体征和症状不典型,易导致误诊和漏诊.结合相应的辅助检查有助于明确诊断.治疗方案的选择须综合考虑瘘口大小、引流量的大小、临床症状以及患者年龄、病程、全身状况等多种因素,制定个体化的治疗方案、选择合适的栓塞材料.

关 键 词:硬脑膜动静脉瘘  海绵窦  诊断  治疗

The clinical analysis of the cavernous dural arteriovenous fistula
Abstract:Objective To explore the clinical manifestations diagnostic features and therapeutic outcome of cavernous sinus dural artenovenous fistula(CSDVF).Methods Clinical data from six patients with CSDVF including clinical symptoms and signs,imaging,treatment and follow-up results were analyzed retrospectively.Follow-up times ranged from 2 months to 2years(means 8.5months).Results Four patients underwent fistula embolization.In these cases the sinus was completely occluded,the symptoms and signs showed marked improvements,visual acuity was improved,and intraocular pressure was maintained within the normal range.One fistula was incompletely blocked with secondary neovaseular glaucoma.One patient who refused fistula embolization underwent enucleation due to secondary neovascular glaucoma.In one case,the fistula became blocked without surgery.Conclusions The early signs and symptoms of CSDVF may be atypical,leading to misdiagnosis and missed diagnoses.Increased attention from ophthalmologists and approconsideration the size of the fistula,flow velocity of the&ainage,and the clinical symptoms as well as the age,disease course,and systemic conditions of the patients to facilitate the development of an individualized treatment protocol.
Keywords:Dural arteriovenous fistula  Cavernous  Diagnosis  Treatment
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