Acierno M D, Trobe J D, Cornblath W T, Gebarski S S
W. K. Kellogg Eye Center, Department of Ophthalmology, USA.
Arch Ophthalmol. 1995 Aug;113(8):1045-9. doi: 10.1001/archopht.1995.01100080097035.
Carotid cavernous fistulas cause conjunctival hyperemia and orbital soft-tissue swelling because of increased flow directed anteriorly in ophthalmic veins. Less well recognized is that when fistular flow is directed posteriorly, these congestive features will be absent and the diagnosis of the "white-eyed shunt" will be missed unless angiography is performed.
Two patients who had oculomotor nerve palsies caused by posteriorly draining dural carotid cavernous fistulas were studied, and the 28 previously described cases were reviewed.
One patient had a chronic painful palsy of the sixth cranial nerve, and the other, a palsy of the third cranial nerve. Cerebral angiography disclosed the fistulas. The clinical and imaging features of these cases conform to those of the 28 previously reported white-eyed shunts. Angiographic features do not explain why some posterior-draining fistulas cause sixth-nerve palsies and others cause third- (or rarely, fourth-) nerve palsies.
Dural carotid cavernous fistulas that drain primarily into the inferior petrosal sinus may cause painful oculomotor palsies that elude diagnosis because they lack congestive orbito-ocular features. Treatment by embolization leads to more rapid resolution of manifestations.
海绵窦瘘因眼静脉向前血流量增加而导致结膜充血和眼眶软组织肿胀。但鲜为人知的是，当瘘管血流向后时，这些充血特征将不存在，除非进行血管造影，否则会漏诊“白睛分流”。
研究了2例因硬脑膜海绵窦瘘向后引流导致动眼神经麻痹的患者，并回顾了之前描述的28例病例。
1例患者出现慢性第六颅神经疼痛性麻痹，另1例出现第三颅神经麻痹。脑血管造影显示了瘘管。这些病例的临床和影像学特征与之前报道的28例白睛分流病例相符。血管造影特征无法解释为什么一些向后引流的瘘管会导致第六神经麻痹，而另一些会导致第三（或很少见的第四）神经麻痹。
主要引流至岩下窦的硬脑膜海绵窦瘘可能导致疼痛性动眼神经麻痹，因缺乏充血性眶眼特征而难以诊断。栓塞治疗可使症状更快缓解。
