Tellouck L, Schweitzer C, Barreau X, Colin J
Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
J Fr Ophtalmol. 2012 Mar;35(3):191.e1-6. doi: 10.1016/j.jfo.2011.03.025. Epub 2011 Sep 9.
We report the case of an 87-year-old patient who developed a dural arteriovenous fistula of the sigmoid sinus with progressive exophthalmia in the opposite eye. The patient had a unilateral decrease in visual acuity; the vessels of the conjunctiva were dilated, and a progressive central retinal vein occlusion occurred in the left eye. A dural carotid cavernous fistula of the right sigmoid sinus was diagnosed with an angiography exam and was successfully treated with embolization of the arteriovenous shunt using Onyx(®). A central partial facial nerve paralysis occurred after embolization and spontaneously resolved in 6 months. Six months after the treatment, visual acuity improved to 7/10 and the exophthalmia and central retinal vein occlusion signs regressed. Dural arteriovenous fistulae are abnormal shunts between a collateral vessel of the carotid artery and the cavernous sinus; the unilateral pulsating exophthalmia is the most frequent associated symptom. Cerebral MRI is useful to analyze indirect signs of the arteriovenous shunt showing an abnormal dilatation of the veins, but angiography of the carotid artery is essential to confirm the diagnosis. Furthermore, it allows treatment of the fistula at the same time, the main complication being the embolization of normal vessels close to the abnormal shunt. The clinical expression of the dural arteriovenous fistula on the opposite eye is infrequent and is related to the presence of complex septae within the cavernous sinus, resulting in a bilateral drainage of the cerebral venous system. The early diagnosis and management of the disease is necessary to improve the visual prognosis.
我们报告了一例87岁患者，其出现了乙状窦硬脑膜动静脉瘘，并伴有对侧眼渐进性眼球突出。患者单眼视力下降；结膜血管扩张，左眼发生了进行性视网膜中央静脉阻塞。经血管造影检查诊断为右侧乙状窦硬脑膜海绵窦瘘，并使用Onyx（®）成功栓塞动静脉分流进行了治疗。栓塞后出现了中枢性部分面神经麻痹，6个月后自行缓解。治疗6个月后，视力提高到7/10，眼球突出和视网膜中央静脉阻塞体征消退。硬脑膜动静脉瘘是颈动脉侧支血管与海绵窦之间的异常分流；单侧搏动性眼球突出是最常见的相关症状。脑部MRI有助于分析动静脉分流的间接征象，表现为静脉异常扩张，但颈动脉血管造影对于确诊至关重要。此外，它还能同时对瘘进行治疗，主要并发症是靠近异常分流的正常血管发生栓塞。硬脑膜动静脉瘘在对侧眼的临床表现并不常见，与海绵窦内存在复杂的间隔有关，导致脑静脉系统双侧引流。该病的早期诊断和治疗对于改善视力预后很有必要。
