Preechawat Pisit, Narmkerd Pison, Jiarakongmun Pakorn, Poonyathalang Anuchit, Pongpech Sirintra M D
Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2008 Jun;91(6):852-8.
To describe the ocular findings, endovascular treatment, and clinical outcome in patients with dural carotid cavernous sinus fistula (CCF).
A retrospective evaluation of 80 consecutive patients who underwent examination and treatment for dural CCF between January 1997 and December 2004 was performed.
Fifty females and 30 males, with an average age of 49 years (from 6 -80 years) participated in this study. All patients had more than one clinical signs and symptoms including proptosis (84%), arterialization of conjunctival vein (93%), chemosis (42%), cranial nerve palsy (52%), elevated intraocular pressure (51%), and optic neuropathy (13%). Diminished vision was found in 43% of the patients. The degree of visual deficit ranged from 20/40 to no light perception. After angiographic evaluation, patients were classified to CCF Barrow's type B 14%, type C 15%, and type D 71%. Endovascular treatment by transvenous and/or transarterial embolization was performed in 60 patients (75%). Carotid-angular compression therapy was solely performed in 19 patients (24%) and was used as an adjunct to endovascular treatment in 30 patients (38%). The follow-up period ranged from 6 to 94 months. Clinical cure was achieved in 41 patients (51%) and improvement in 30 patients (38%). Anatomical cure was demonstrated by angiogram in 50 patients (63%). Intra-operative complications were found in three patients including ophthalmic artery occlusion and cerebral infarction. Eight patients experienced transient aggravation of symptoms including increased proptosis, elevation of intraocular pressure, choroidal detachment that required suprachoroidal drainage, and venous stasis retinopathy. Ophthalmic vein thrombosis resulting in central retinal vein occlusion was developed in three patients and finally caused severe visual deficit. There was no operative mortality.
Selective management with endovascular therapy and manual compression are the effective treatment for dural CCF. However sight-threatening complications can develop after therapy due to progressive ophthalmic vein thrombosis and should be carefully monitored.
描述硬脑膜型颈内动脉海绵窦瘘（CCF）患者的眼部表现、血管内治疗及临床结果。
对1997年1月至2004年12月期间连续80例接受硬脑膜型CCF检查和治疗的患者进行回顾性评估。
本研究纳入50例女性和30例男性，平均年龄49岁（6 - 80岁）。所有患者均有不止一种临床体征和症状，包括眼球突出（84%）、结膜静脉动脉化（93%）、球结膜水肿（42%）、脑神经麻痹（52%）、眼压升高（51%）和视神经病变（13%）。43%的患者视力下降。视力缺损程度从20/40到无光感不等。血管造影评估后，患者被分为CCF Barrow B型14%、C型15%和D型71%。60例患者（75%）接受了经静脉和/或经动脉栓塞的血管内治疗。19例患者（24%）仅接受了颈动脉 - 角静脉压迫治疗，30例患者（38%）将其作为血管内治疗的辅助手段。随访期为6至94个月。41例患者（51%）实现临床治愈，30例患者（38%）病情改善。血管造影显示50例患者（63%）实现解剖治愈。3例患者出现术中并发症，包括眼动脉闭塞和脑梗死。8例患者经历症状短暂加重，包括眼球突出增加、眼压升高、脉络膜脱离（需要脉络膜上腔引流）和静脉淤滞性视网膜病变。3例患者发生眼静脉血栓形成导致视网膜中央静脉阻塞，最终导致严重视力缺损。无手术死亡病例。
血管内治疗和手法压迫的选择性管理是硬脑膜型CCF的有效治疗方法。然而，由于进行性眼静脉血栓形成，治疗后可能出现威胁视力的并发症，应仔细监测。
