16例颈动脉海绵窦瘘眼部表现和临床分析

Clinical analysis and ocular manifestation in 16 patients with carotid cavernous fistula

关键词:  颈动脉海绵窦瘘  眼部表现  鉴别诊断  误诊

Key words:  [Key words]　carotid cavernous fistula  ocular manifestation  differential diagnosis  misdiagnosis

摘要:

[摘要]　目的　分析颈动脉海绵窦瘘(CCF)的临床特点和鉴别诊断，提高对该病的认识,减少误诊和漏诊。　方法　回顾性分析16例颈动脉海绵窦瘘患者的眼部表现、影像学特点和治疗方法，比较直接型和间接型CCF的临床特点。　结果　结膜充血水肿(93.8%)、眼球突出(81.3%)是CCF最常见的体征。易误诊为青光眼、眼眶炎性假瘤以及甲状腺相关性眼病等。直接型比间接型CCF更易引起颅内血管杂音（P=0.014）。接受血管内栓塞治疗者眼部症状及体征改善明显。　结论　颈动脉海绵窦瘘的眼部表现多种多样,结合病史、特征性眼部体征以及DSA等影像学检查可有效提高诊断率。血管内栓塞治疗对改善眼部表现疗效显著。

Abstract:

[Abstract] Objective　To analyze the clinical features and differential diagnosis of carotid cavernous sinus fistulas (CCF) in order to improve the recognition and avoid misdiagnosis. 〖WTHZ〗Methods〖WTBZ〗 Clinical data from 16 patients with carotid -cavernous sinus fistula including ocular manifestation, imaging, treatment were analyzed retrospectively. Differences between the direct and the indirect CCF were compared. 〖WTHZ〗Results〖WTBZ〗 The most common signs of CCF were conjunctival injection or chemosis (93.8%) and proptosis (81.3%)．Intracranial vascular murmur was more prevalent in patients with direct CCF．CCF may be misdiagnosed as glaucoma，thyroid associated ophthalmopathy, and orbital inflammatory pseudotumor. The ocular symptoms improved apparently in all cases after embolization therapy. 〖WTHZ〗Conclusion〖WTBZ〗 Although the ocular manifestation of carotid cavernous fistula are varied, combination of medical history, characteristic ocular signs and DSA imaging examination can improve the diagnosis. Endovascular embolization is a suitable treatment of the CCF with good prognosis.