Pe Yan Mary Rose, Sobrio Maria Clarissa S, Ranche Felice Katrina T
Department of Ophthalmology and Visual Sciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2024 May 15;58(8):76-91. doi: 10.47895/amp.vi0.6550. eCollection 2024.
A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the internal carotid artery and/or the external carotid artery and the cavernous sinus. There is a paucity of information on the ophthalmic outcomes of endovascular treatment for CCF in the Philippines.
This study aimed to describe the clinical experience of CCF in our institution in order to further our understanding of the disease. This study described the demographic profile, risk factors, and clinical features of patients with CCF, and compared the data of patients according to the type of CCF. The study discussed the changes in clinical features over time in CCF patients who chose not to undergo endovascular treatment. The study also discussed the clinical outcomes of CCF patients who underwent endovascular treatment and compared the clinical outcomes to CCF patients who did not undergo endovascular treatment.
A retrospective cohort study design was performed using a medical record review of patients clinically diagnosed with CCF from January 2011 to June 2019.
One hundred twenty medical records of patients diagnosed with CCF were included. Based on angiographic findings, patients were grouped according to type of CCF, with 86 patients in Group 1 or Direct CCF, 23 patients in Group 2 or Indirect CCF, and 11 patients in Group 3 or Mixed type of CCF. The patients were also grouped according to treatment, with 109 patients in Group A, or patients who did not undergo endovascular treatment, and 11 patients in Group B, or patients who underwent endovascular treatment. There was a male predominance in CCF, most occurring in the age range of 26 to 35 years. Risk factors for CCF were trauma and hypertension. Clinical features included the presence of blurring of vision, proptosis, corkscrewing of conjunctival vessels, extraocular movement limitation, diplopia, audible bruit, elevated intraocular pressure, and pulsation. Findings on Computed Tomography scan included dilated superior ophthalmic vein, proptosis, and enlarged extraocular muscles. Direct CCF (Group 1) occurred mostly in males, with mean age of 39.1 years, and with trauma as the major risk factor. Indirect CCF (Group 2) occurred mostly in females, with mean age of 52.1 years, and with hypertension as the major risk factor. Regardless of the type of CCF, patients who did not undergo endovascular treatment can exhibit spontaneous improvement or worsening of clinical features. Patients who underwent endovascular treatment generally had favorable clinical outcomes, manifesting as either improvement or no worsening of features. There were minimal ophthalmic complications associated with treatment.
Endovascular treatment is safe and effective in the improvement of visual acuity, corkscrewing of conjunctival vessels, amount of proptosis, extraocular movement limitation, diplopia, and presence of audible bruit.
颈动脉海绵窦瘘（CCF）是颈内动脉和/或颈外动脉与海绵窦之间的异常交通。菲律宾关于CCF血管内治疗的眼科预后的信息匮乏。
本研究旨在描述我们机构中CCF的临床经验，以增进我们对该疾病的了解。本研究描述了CCF患者的人口统计学特征、危险因素和临床特征，并根据CCF的类型对患者数据进行了比较。该研究讨论了选择不接受血管内治疗的CCF患者临床特征随时间的变化。该研究还讨论了接受血管内治疗的CCF患者的临床结局，并将临床结局与未接受血管内治疗的CCF患者进行了比较。
采用回顾性队列研究设计，对2011年1月至2019年6月临床诊断为CCF的患者进行病历回顾。
纳入了120例诊断为CCF的患者病历。根据血管造影结果，患者按CCF类型分组，1组或直接CCF有86例患者，2组或间接CCF有23例患者，3组或混合型CCF有11例患者。患者也按治疗情况分组，A组有109例患者，即未接受血管内治疗的患者，B组有11例患者，即接受血管内治疗的患者。CCF以男性居多，大多发生在26至35岁年龄范围。CCF的危险因素是创伤和高血压。临床特征包括视力模糊、眼球突出、结膜血管螺旋状扭曲、眼球运动受限、复视、可闻及的杂音、眼压升高和搏动。计算机断层扫描结果包括眼上静脉扩张、眼球突出和眼外肌增大。直接CCF（1组）大多发生在男性，平均年龄39.1岁，主要危险因素是创伤。间接CCF（2组）大多发生在女性，平均年龄52.1岁，主要危险因素是高血压。无论CCF的类型如何，未接受血管内治疗的患者临床特征可自发改善或恶化。接受血管内治疗的患者一般临床结局良好，表现为特征改善或未恶化。治疗相关的眼科并发症极少。
血管内治疗在改善视力、结膜血管螺旋状扭曲、眼球突出程度、眼球运动受限情况、复视及可闻及的杂音方面安全有效。
