颈内动脉海绵窦瘘眼部并发症的诊断和治疗

Diagnosis and therapy of carotid cavernous fistula with ocular complications

目的探讨颈内动脉海绵窦瘘眼部并发症的临床特征和治疗方法，以免误诊误治。方法经脑系外科确诊并住院治疗的颈内动脉海绵窦瘘患者20例纳入研究。所有患者均因出现眼部症状首诊眼科。其中男性12例，女性8例，年龄21～59岁，平均年龄（40＋1．9）岁。所有患者均行视力、裂隙灯显微镜、眼底彩色照像检查以及复视、眼球突m度、眼眶颞部听诊、眼肌运动检查和非接触眼压检查。明确诊断后均行血管内栓塞手术。结果20例患者均为双眼病变，主述有视力下降14例（28只眼），占70％；复视8例（16只眼），占40％；球结膜充血水肿13例（26只眼），占65％；眼球突出10例（20只眼），占50％，眼眶颞部听诊有杂音6例（12只眼），占30％；眼肌麻痹12例（24只眼），占60％：眼底改变11例（22只眼），占55％。眼压23—32mmHg7例（14只眼），占35％。手术后患者主述症状均消失。结论对不明原因的视力下降、眼红并突出、眼肌麻痹或伴青光眼患者应高度怀疑颈内动脉海绵窦瘘，并首选DSA检查和血管内栓塞术。

Objective To investigate the clinical diagnosis and therapy of carotid cavernous fistula with ocular complications. Methods A retrospective study covering 20 patients who was diagnosed with carotid cavernous fistula in Department of Neurological Surgery, First Municipal People＇s Hospital of Guangzhou, Guangzhou, was performed. Clinical data from all patients including the med- ical history, ocular manifestations, color fundus photographs, ocular and intracranial pressure, magnet- ic resonance imaging （MRI）, and digital subtraction angiography （DSA）, were reviewed. Results In 20 patients （40 eyes） with ocular symptoms, decreased visual acuity occurred in 14 cases （28 eyes; 70%）, diplopia in 8 patients （16 eyes; 40%）, conjunctival congestion and edema in 13 cases （26 eyes; 65%）, proptosis in 10 cases （20 eyes; 50%）, orbital temporal noise in 6 cases （12 eyes; 30%）, ophthalmoplegia in 12 cases （24 eyes; 60%）, pathologic fundus changes in 11 patients （22 eyes; 55%）, ocular pressure increase in 7 cases （14 eyes; 35%）. All patients were cured successfully after endovascular embolization treatment. Conclusions Carotid cavernous fistula should be considered as an important differential diagnosis in patients presented with conjunctival hyperemia, proptosis, oph- thalmoplegia, or glaucoma. The DSA examination can contribute to a definite diagnosis of carotid cavernous fistula, and the endovascular embolization is the first preferred treatment.