直接型颈动脉海绵窦瘘的临床特征:与间接型颈动脉海绵窦瘘的比较

目的探讨直接型和间接型颈动脉海绵窦瘘(carotid-cavernous fistula,CCF)患者的临床特征。方法回顾性纳入2010年1月至2020年8月在徐州医科大学附属医院住院治疗的CCFs患者,收集相关临床资料,包括主要临床表现、神经影像学特征和治疗方法,对直接型与间接型CCFs的临床特征进行比较。结果共纳入31例CCFs患者,29例(93.5%)伴有眼部症状,以结膜充血水肿(24例,77.4%)、眼球突出(19例,61.3%)和眼眶杂音(18例,58.1%)最多见。直接型CCFs组23例(74.2%),间接型CCFs组8例(25.8%),前者多有头颅外伤史(78.2%对12.5%;P=0.002)、流量更大(高流量CCFs:100%对37.5%;P<0.001)、更易引起眼眶杂音(69.6%对25.0%;P=0.043)。血管内栓塞治疗安全有效,EVAL胶联合弹簧圈栓塞(18例,66.7%)和单纯可脱式球囊栓塞(6例,22.2%)为常用的血管内栓塞方式。结论CCFs以眼部表现最为突出。直接型CCFs更多见,通常有头颅外伤史,临床和影像学征象更典型。介入栓塞是CCFs患者的首选治疗方案。

Clinical features of direct carotid cavernous fistulas:comparison with indirect carotid cavernous fistulas

Objective To investigate the clinical features of direct and indirect carotid cavernous fistulas(CCFs).Methods Patients with CCF treated in the Affiliated Hospital of Xuzhou Medical University from January 2010 to August 2020 were enrolled retrospectively.Relevant clinical data were collected,including the main clinical manifestations,neuroimaging features,and treatment methods.The clinical features of direct and indirect CCFs were compared.Results A total of 31 patients were enrolled in the study,29(93.5%)had ocular symptoms,of which conjunctival hyperemia and edema(n=24,77.4%),exophthalmos(n=19,61.3%)and orbital murmur(n=18,58.1%)were most common.There were 23 patients(74.2%)in direct CCF group and 8(25.8%)in indirect CCF group.The former had more history of head trauma(78.2%vs.12.5%;P=0.002),more flow volume(high-flow CCFs:100%vs.37.5%;P<0.001)and more likely to cause orbital murmur(69.6%vs.25.0%;P=0.043).Endovascular embolization was safe and effective.The common methods of endovascular embolization were EVAL glue combined with coil embolization(n=18,66.7%)and detachable balloon embolization alone(n=6,22.2%).Conclusion Ocular manifestations are most prominent in patients with CCFs.Direct CCF is more common,usually with a history of head trauma,and the clinical and imaging features are more typical.Interventional embolization is the preferred treatment option for patients with CCF.