血管内线圈栓塞治疗直接颈动脉-海绵窦瘘后迟发性颅神经麻痹。
Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas.
机构信息
Departments of Ophthalmology, Neurology, and Neurosurgery (ABG, PSS), University of Colorado School of Medicine, Aurora, Colorado.
出版信息
J Neuroophthalmol. 2018 Jun;38(2):156-159. doi: 10.1097/WNO.0000000000000568.
BACKGROUND
Late recurrence of visual symptoms associated with carotid-cavernous fistula (CCF), including diplopia, is uncommon and raises concern for new or recurrent fistula formation.
METHODS
We report 2 patients with traumatic CCFs, where cranial nerve paresis resolved after endovascular CCF treatment only to reappear years later.
RESULTS
No evidence of recurrent or new fistula formation was found. Both were treated successfully with strabismus surgery.
CONCLUSIONS
Although the cause of delayed onset diplopia after successful treatment is still unknown, theories include late compression of cranial nerves within the cavernous sinus due to coil mass that can cause chronic ischemia, delayed inflammation due to a thrombophilic nidus created by the coil mass, or injury to the cranial nerves that manifests later due to decompensated strabismus.
背景
与颈动脉海绵窦瘘（CCF）相关的视觉症状（包括复视）迟发复发并不常见，但需要考虑新瘘或复发瘘的形成。
方法
我们报告了 2 例创伤性 CCF 患者，其颅神经麻痹在血管内 CCF 治疗后得到缓解，但数年后再次出现。
结果
未发现新瘘或复发瘘的形成。两者均通过斜视手术成功治疗。
结论
尽管成功治疗后迟发性复视的原因仍不清楚，但理论包括：由于线圈团块导致海绵窦内颅神经慢性受压引起缺血，由于线圈团块形成的血栓形成性核心导致延迟炎症，或由于代偿性斜视导致的颅神经损伤，这些损伤表现较晚。
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