Al-Shalchy Ali, Al-Wassiti Ahmed S, Hashim Mohammed A, Al-Khazaali Younus M, Talib Sura H, Bani-Saad Ali A, Al-Taie Rania H, Ismail Mustafa
Department of Surgery, College of Medicine, University of Baghdad, Baghdad, IRQ.
Department of Surgery, College of Medicine, Al-Nahrain University, Baghdad, IRQ.
Cureus. 2024 Jul 31;16(7):e65821. doi: 10.7759/cureus.65821. eCollection 2024 Jul.
Carotid-cavernous fistulas (CCFs) are pathologic, arteriovenous communications between the carotid artery and cavernous sinus. They cause various complex neuro-ophthalmic symptoms by shunting the flow of arterial blood into the venous system. In this study, a systematic review is conducted on the neuro-ophthalmic presentations associated with CCFs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed during the systematic review. We searched PubMed, Scopus, and Web of Science from inception to December 31, 2023. Articles written in English on patients with confirmed CCFs reporting clinical features, diagnostic modalities, treatment approaches, and outcomes were included. Abstracted data included demography, clinical presentations, venous flow dynamics, trauma history, investigative methodology, approaches to treatment, and outcomes. Overall, 33 studies with a total number of 403 patients were included. The mean age at presentation was 42.99 years for patients with direct CCFs and 55.88 years for those with indirect CCFs. Preponderance was observed in male patients with direct CCFs, constituting 51.56%, while females predominated in those with indirect CCFs, at 56.44%. The clinical symptoms in all patients with CCFs were proptosis in 58 cases (14.39%), conjunctival congestion in 29 patients (7.20%), diplopia in nine patients (2.23%), vision blurring in four patients (0.99%), eyelid swelling in five patients (1.24%), pain in the eye in three patients (0.74%), and an upper lid mass in one patient (0.25%). Endovascular treatments, including coil and Onyx embolization, have been effective in relieving clinical symptoms and arresting the progression of these symptoms. In conclusion, the common clinical features in CCFs usually underline proptosis, congestion, and diplopia, necessitating a comprehensive neuro-ophthalmological review. Prompt identification of the symptoms of blurred vision is crucial to avoid permanent damage. Lid swelling, ocular pain, and an upper lid mass are less common but equally essential presentations for comprehensive evaluation. The recognition of these variable presentations is essential not only for timely intervention but also for the improvement in patient outcomes, thus emphasizing the role of clinician awareness in managing CCF cases.
颈动脉海绵窦瘘（CCF）是颈动脉与海绵窦之间的病理性动静脉交通。它们通过将动脉血流分流到静脉系统而导致各种复杂的神经眼科症状。在本研究中，对与CCF相关的神经眼科表现进行了系统评价。系统评价过程遵循了《系统评价和Meta分析的首选报告项目2020》指南。我们检索了PubMed、Scopus和Web of Science数据库，检索时间从建库至2023年12月31日。纳入了用英文撰写的关于确诊CCF患者的文章，这些文章报告了临床特征、诊断方式、治疗方法和结果。提取的数据包括人口统计学、临床表现、静脉血流动力学、创伤史、调查方法、治疗方法和结果。总体而言，共纳入33项研究，涉及403例患者。直接CCF患者的平均就诊年龄为42.99岁，间接CCF患者为55.88岁。直接CCF男性患者居多，占51.56%，而间接CCF女性患者居多，占56.44%。所有CCF患者的临床症状中，眼球突出58例（14.39%），结膜充血29例（7.20%），复视9例（2.23%），视力模糊4例（0.99%），眼睑肿胀5例（1.24%），眼痛3例（0.74%），上睑肿物1例（0.25%）。血管内治疗，包括弹簧圈和Onyx栓塞，已有效地缓解了临床症状并阻止了这些症状的进展。总之，CCF的常见临床特征通常为眼球突出、充血和复视，需要进行全面的神经眼科检查。及时识别视力模糊症状对于避免永久性损伤至关重要。眼睑肿胀、眼痛和上睑肿物虽较少见，但同样是全面评估的重要表现。认识到这些不同的表现不仅对及时干预至关重要，而且对改善患者预后也很重要，从而强调了临床医生意识在处理CCF病例中的作用。
