Yilmaz Umut
Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str., Gebäude 90.4, 66421, Homburg, Deutschland.
Radiologie (Heidelb). 2024 Mar;64(3):182-188. doi: 10.1007/s00117-024-01269-1. Epub 2024 Feb 13.
Carotid cavernous fistulas (CCFs) are rare but clinically significant vascular anomalies characterized by abnormal connections between the cavernous sinus and arteries. This overview presents a comprehensive analysis of anatomy, classification, clinical presentation, diagnosis, imaging, and therapy of CCFs. The cavernous sinus, a central venous structure in the brain, is of critical importance for understanding CCFs due to its proximity to key structures such as the internal carotid artery and cranial nerves.
CCFs are classified into direct and dural types, with direct fistulas typically being high-flow and dural fistulas being low-flow. The symptomatology varies greatly and can range from noises in the head, diplopia, red eye, tearing, to blurred vision and headaches. The diagnostic assessment requires a combination of detailed medical history, neurological and ophthalmological examination, and the use of imaging techniques.
In imaging, computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for depicting the anatomical structures and blood vessels, while digital subtraction angiography (DSA) is considered the gold standard for accurate representation of the fistula. The treatment of CCFs is complex and depends on the type of fistula, location, and clinical condition of the patient.
This overview emphasizes the importance of precise diagnosis and individualized therapy to achieve optimal results and avoid complications. Ongoing developments in medical imaging and treatment techniques will continuously improve the treatment outcomes of patients with CCFs.
颈动脉海绵窦瘘(CCF)虽罕见,但具有临床意义,其特征为海绵窦与动脉之间存在异常连接。本综述对CCF的解剖、分类、临床表现、诊断、影像学及治疗进行了全面分析。海绵窦是脑内的一个中央静脉结构,因其靠近颈内动脉和颅神经等关键结构,对于理解CCF至关重要。
CCF分为直接型和硬脑膜型,直接瘘通常为高流量,硬脑膜瘘为低流量。其症状差异很大,可从头部杂音、复视、眼红、流泪到视力模糊和头痛。诊断评估需要详细的病史、神经和眼科检查以及影像学技术的综合应用。
在影像学方面,计算机断层扫描(CT)和磁共振成像(MRI)对于描绘解剖结构和血管至关重要,而数字减影血管造影(DSA)被认为是准确显示瘘管的金标准。CCF的治疗复杂,取决于瘘管类型、位置及患者的临床状况。
本综述强调了精确诊断和个体化治疗对于取得最佳效果及避免并发症的重要性。医学影像学和治疗技术的不断发展将持续改善CCF患者的治疗效果。