海绵窦造影在颈动脉-海绵窦瘘及其并发症中的诊断和治疗意义

The diagnostic and therapeutic significance of cavernous sinography in CCF and its complication

目的 了解颈动脉一海绵窦瘘(carotid-cavernous fistula,CCF)的血流动力学变化和颈内动脉海绵窦段及其周围静脉窦和静脉的病理改变,为制定更为合理的治疗方案提供依据。方法 1990年4月～1999年4月共收治CCF患者124例,28例施行眼上静脉(superior ophthalmic vein,SOV)海绵窦造影,其中A型17例,B型1例,D型10例。结果 海绵窦造影显示,海绵窦接近正常者12例(42.86％),其中海绵窦狭窄3例,网状海绵窦9例。海绵窦扩大者16例(57.14％),包括局限性扩张呈静脉湖状14例,其中海绵窦囊性占位者5例,即囊中囊表现,提示存在外伤性动脉瘤;海绵窦分隔2例。辅助动脉造影检查发现,CCF合并同侧颈动脉闭塞者2例,颈动脉狭窄3例,合并外伤性动脉瘤5例,其中2例发生严重鼻出血。28例均经眼上静脉入路或眼上静脉+动脉入路闭塞CCF及假性动脉瘤,治疗效果良好。结论 眼上静脉-海绵窦造影与颈动脉造影结合,于动脉外闭塞CCF瘘口或闭塞海绵窦瘘,可提高CCF治疗的成功率并保持载瘘动脉的通畅率,有助于CCF合并颈内动脉海绵窦段损伤及外伤性动脉瘤的诊断与治疗。

Objective The hemodynamic pattern of carotid-cavernous fistula (CCF) and the pathological change of the cavernous sinus segment of internal carotid artery and its surrounding venous sinus and veins were studied to provide the basis of laying down a more rational therapeutic plan. Methods A total of 124 patients with CCF were admitted during April 1990 to April 1999. Twenty-eight patients were taking cavernous sinography via superior ophthalmic vein (SOV) and there were type A CCF 17 cases, type B CCF 1 case and type D CCF 10 cases. Results The cavernous sinography showed that there were enlargement of cavernous sinus 16 cases (57.14%) including local enlargement as venous lake, cystic, occupancy of cavernous sinus ie intracapsular cyst occurrence demonstrated the existence of traumatic aneurysm, cavenous sinus septation, cavernous sinus stenosis and reticular cavernous sinus. It was found from assist arteriography there were CCF complicated with homolateral carotid obliteration 2cases, carotid stenosis 3cases, combining with traumatic aneurysm 5 cases (2 of the 5 cases with severe rhinorrhagia). The occlusion of CCF and false aneurysm were performed via SOV or SOV+ artery access with good effect in 28 cases. Conclusion Under the combination of SOV-cavernous sinography with arteriography, occlusion of CCF fistula or cavernous sinus fistula outside the artery may improve the therapeutic successful rate of CCF and maintain the free circulation of fistula carrying artery. Thus it is helpful for the diagnosis and treatment of CCF complicated with the injury of internal carotid artery in cavernous sinus segment and traumatic aneurysm.