Kai Yutaka, Hamada Jun-ichiro, Morioka Motohiro, Yano Shigetoshi, Kuratsu Jun-ichi
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Neurosurgery. 2007 Feb;60(2):253-7; discussion 257-8. doi: 10.1227/01.NEU.0000249274.49192.3B.
External manual carotid compression is a noninvasive method to treat cavernous sinus (CS) dural arteriovenous fistulae (DAVF). We studied a group of patients with CS-DAVF to identify what factors made complete resolution of their clinical symptoms and closure of the DAVF on magnetic resonance angiography (MRA) by compression therapy possible.
We treated 23 patients with CS-DAVF without cortical venous drainage or a recent decline in visual acuity by compression therapy. All were followed up by magnetic resonance angiography at 1, 3, 6, and 12 months after treatment and the characteristics of the imaging findings, their neurological symptoms, and the patterns of symptom improvement were examined.
In Group A (n = 8), complete resolution was achieved by manual carotid compression. In the other 15 patients (Group B), complete resolution was not obtained. Group B manifested significantly higher ocular pressure and a significantly longer interval between symptom onset and compression treatment. In Group A, venous drainage was via the superior orbital vein with or without involvement of the inferior petrosal sinus. Closure of the CS-DAVF occurred within 4.1 months after the start of treatment. In three patients, symptom improvement progressed steadily and gradually. The other five patients with complete resolution experienced transient worsening of their symptoms at 2 to 4 months after the start of treatment and symptom resolution occurred within 4 to 7 months.
We identified lower ocular pressure, a shorter interval between symptom onset and compression treatment, and venous drainage solely via the superior orbital vein without involvement of the inferior petrosal sinus as the factors in our CS-DAVF patients that made complete resolution by manual carotid compression possible.
颈外动脉手法压迫是一种治疗海绵窦（CS）硬脑膜动静脉瘘（DAVF）的非侵入性方法。我们研究了一组CS-DAVF患者，以确定哪些因素使得通过压迫疗法能使他们的临床症状完全缓解且磁共振血管造影（MRA）显示DAVF闭合。
我们对23例无皮质静脉引流或近期视力下降的CS-DAVF患者进行了压迫疗法治疗。所有患者在治疗后1、3、6和12个月接受磁共振血管造影随访，并检查成像结果的特征、神经症状以及症状改善模式。
A组（n = 8）通过颈外动脉手法压迫实现了完全缓解。在其他15例患者（B组）中，未实现完全缓解。B组表现出明显更高的眼压以及症状出现至压迫治疗之间的间隔明显更长。在A组中，静脉引流通过眶上静脉，伴或不伴有岩下窦受累。CS-DAVF在治疗开始后4.1个月内闭合。3例患者症状改善稳步且逐渐进展。其他5例完全缓解的患者在治疗开始后2至4个月出现症状短暂恶化，症状缓解发生在4至7个月内。
我们确定较低的眼压、症状出现至压迫治疗之间较短的间隔以及仅通过眶上静脉引流而无岩下窦受累是我们CS-DAVF患者中通过颈外动脉手法压迫实现完全缓解的因素。
