Kurata A, Takano M, Tokiwa K, Miyasaka Y, Yada K, Kan S
Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa Prefecture, Japan.
AJNR Am J Neuroradiol. 1993 Sep-Oct;14(5):1097-101.
To discuss the differences in angiographic findings between cases of spontaneous carotid cavernous fistula with and without the classical triad of symptoms (pulsating exophthalmos, bruit, and conjunctival chemosis).
With CT, MR, and angiography, we examined 12 cases of spontaneous carotid cavernous fistula, five of whom presented only with cranial nerve palsies.
In the seven cases with the triad, the main venous drainage from the cavernous sinus was the superior ophthalmic vein. Only one or two veins drained the cavernous sinus, and cortical venous drainage was not present in any case. In contrast, all but one case with only cranial nerve palsies had at least three venous drainage routes from the cavernous sinus, including cortical venous drainage.
For the diagnoses of spontaneous carotid cavernous fistula, it is important to know that some patients do not show the classical triad of symptoms. In such patients, early diagnosis and treatment are particularly important because cortical venous drainage and a consequent risk of hemorrhage are frequently present.
探讨有或无典型三联征症状（搏动性眼球突出、杂音和结膜水肿）的自发性颈动脉海绵窦瘘病例在血管造影表现上的差异。
我们通过CT、MR和血管造影检查了12例自发性颈动脉海绵窦瘘患者，其中5例仅表现为颅神经麻痹。
在有三联征的7例患者中，海绵窦的主要静脉引流为眼上静脉。仅有一或两条静脉引流海绵窦，且无一例存在皮质静脉引流。相比之下，除1例仅有颅神经麻痹的患者外，其余所有患者至少有三条来自海绵窦的静脉引流途径，包括皮质静脉引流。
对于自发性颈动脉海绵窦瘘的诊断，重要的是要知道有些患者不会表现出典型的三联征症状。在这类患者中，早期诊断和治疗尤为重要，因为经常存在皮质静脉引流以及随之而来的出血风险。
