海绵窦区硬脑膜动静脉瘘的临床观察分析

The clinical analysis of the cavernous dural arteriovenous fistula

目的探讨海绵窦区硬脑膜动静脉瘘的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临床症状及体征、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。

Objective To explore the clinical manifestations diagnostic features and therapeutic outcome of cavernous sinus dural arteriovenous fistula （CSDVF）. Methods Clinical data from six patients with CSDVF including clinical symptoms and signs, imaging, treatment and follow-up results were analyzed retro- spectively. Follow-up times ranged from 2 months to 2 years （means 8.5 months）. 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 neovascular 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 appropriate auxiliary examination should improve diagnosis. The selection of therapeutic methods should take into consideration the size of the fistula, flow velocity of the drainage, 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.