Das Sunit, Bendok Bernard R, Novakovic Roberta L, Parkinson Richard J, Rosengart Axel J, Macdonald R Loch, Frank Jeffrey I
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Surg Neurol. 2006 Jul;66(1):82-5; discussion 85. doi: 10.1016/j.surneu.2005.10.008.
Carotid cavernous sinus fistulae are abnormal communications between the carotid circulation and cavernous sinus that may arise spontaneously or develop after craniocerebral trauma. They may present with a constellation of signs and symptoms characteristic of raised cavernous sinus pressure, including orbital or retro-orbital pain, pulsatile proptosis, chemosis, ocular or cranial bruit, deterioration of visual acuity, or ophthalmoplegia. Visual loss is likely the result of multiple insults to the visual system, including reversal of venous drainage from the fistula, arterial flow into the superior ophthalmic vein, increased intraocular venous pressure, venous stasis retinopathy, and eventually ischemic optic neuropathy [Brodsky MC, Hoyt WF, Halbach VV, et al. Recovery from total monocular blindness after balloon embolization of carotid-cavernous fistula. Am J Ophthalmol 1987;104:86-87; Sanders MD, Hoyt WF. Hypoxic ocular sequelae of carotid-cavernous fistulae: study of the causes of visual failure before and after neurosurgical treatment in a series of 25 cases. Br J Ophthalmol 1969;53:82-97].
With few exceptions, the literature is replete with evidence of persistent blindness despite successful treatment of the CCF [Albuquerque FC, Heinz GW, McDougall CG. Reversal of blindness after transvenous embolization of a carotid-cavernous fistula: case report. Neurosurgery 2003;52:233-237; Brodsky MC, Hoyt WF, Halbach VV, et al. Recovery from total monocular blindness after balloon embolization of carotid-cavernous fistula. Am J Ophthalmol 1987;104:86-87; Weinstein JM, Rufenacht DA, Partington CR, et al. Delayed visual loss due to trauma of the internal carotid artery. Arch Neurol. 1991;48:490-497]. Here, we report a patient who experienced recovery of vision after endovascular obliteration of the offending CCF.
To our knowledge, this is the second reported case of recovery of visual function in a patient presenting with loss of light perception after treatment of a direct CCF.
颈动脉海绵窦瘘是颈动脉循环与海绵窦之间的异常交通，可自发出现或在颅脑外伤后形成。其可能表现出一系列海绵窦压力升高的体征和症状，包括眼眶或眶后疼痛、搏动性眼球突出、球结膜水肿、眼部或头部杂音、视力下降或眼肌麻痹。视力丧失可能是视觉系统受到多种损害的结果，包括瘘口静脉引流逆转、动脉血流入眼上静脉、眼内静脉压升高、静脉淤滞性视网膜病变，最终导致缺血性视神经病变[布罗德斯基MC，霍伊特WF，哈尔巴赫VV等。颈动脉海绵窦瘘球囊栓塞术后单眼完全失明恢复。美国眼科杂志1987；104：86 - 87；桑德斯MD，霍伊特WF。颈动脉海绵窦瘘的缺氧性眼部后遗症：25例神经外科治疗前后视力丧失原因的研究。英国眼科杂志1969；53：82 - 97]。
除少数例外，尽管颈动脉海绵窦瘘（CCF）治疗成功，但文献中充斥着持续失明的证据[阿尔伯克基FC，海因茨GW，麦克杜格尔CG。颈动脉海绵窦瘘经静脉栓塞后失明逆转：病例报告。神经外科学2003；52：233 - 237；布罗德斯基MC，霍伊特WF，哈尔巴赫VV等。颈动脉海绵窦瘘球囊栓塞术后单眼完全失明恢复。美国眼科杂志1987；104：86 - 87；温斯坦JM，鲁费纳赫特DA，帕廷顿CR等。颈内动脉创伤导致的延迟性视力丧失。神经病学档案。1991；48：490 - 497]。在此，我们报告1例患者在对导致问题的CCF进行血管内闭塞治疗后视力恢复。
据我们所知，这是第二例报道的直接型CCF治疗后出现光感丧失的患者恢复视觉功能的病例。
