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目的 了解颈动脉一海绵窦瘘(carotid-cavernous fistula,CCF)的血流动力学变化和颈内动脉海绵窦段及其周围静脉窦和静脉的病理改变,为制定更为合理的治疗方案提供依据。方法 1990年4月～1999年4月共收治CCF患者124例,28例施行眼上静脉(superior ophthalmic vein,SOV)海绵窦造影,其中A型17例,B型1例,D型10例。结果 海绵窦造影显示,海绵窦接近正常者12例(42.86％),其中海绵窦狭窄3例,网状海绵窦9例。海绵窦扩大者16例(57.14％),包括局限性扩张呈静脉湖状14例,其中海绵窦囊性占位者5例,即囊中囊表现,提示存在外伤性动脉瘤;海绵窦分隔2例。辅助动脉造影检查发现,CCF合并同侧颈动脉闭塞者2例,颈动脉狭窄3例,合并外伤性动脉瘤5例,其中2例发生严重鼻出血。28例均经眼上静脉入路或眼上静脉+动脉入路闭塞CCF及假性动脉瘤,治疗效果良好。结论 眼上静脉-海绵窦造影与颈动脉造影结合,于动脉外闭塞CCF瘘口或闭塞海绵窦瘘,可提高CCF治疗的成功率并保持载瘘动脉的通畅率,有助于CCF合并颈内动脉海绵窦段损伤及外伤性动脉瘤的诊断与治疗。
Objective To understand the hemodynamic changes of carotid-cavernous fistula (CCF) and the pathological changes of the carotid cavernous sinus and its surrounding sinuses and veins in order to provide a basis for making a more rational treatment plan . Methods From April 1990 to April 1999, 124 patients with CCF and 28 patients with superior ophthalmic vein (SOV) underwent cavernous sinus imaging. Among them, 17 were type A, 1 was type B and 10 was type D. Results Cavernous sinus angiography showed that 12 cases (42.86%) had normal cavernous sinus, including 3 cases of cavernous sinus stenosis and 9 cases of reticular cavernous sinus. There were 16 cases of cavernous sinus enlargement (57.14%), including 14 cases of venous lachrymal expansion. Among them, 5 cases of cystic cavernous space occupying cystic capsule showed the presence of traumatic aneurysm. Cavernous sinus septum 2 example. Auxiliary angiography showed that 2 cases of CCF with ipsilateral carotid artery occlusion, 3 cases of carotid artery stenosis, 5 cases of traumatic aneurysm, of which 2 cases of severe epistaxis. All 28 cases were treated by superior or inferior ophthalmic artery occlusion of CCF and pseudoaneurysm, the treatment effect is good. Conclusions The combination of ophthalmic vein-cavernous sinus angiography with carotid artery angiography can block the CCF fistula or occlusion of cavernous fistula. It can improve the success rate of CCF treatment and maintain the patency rate of the fistula artery, which can help the CCF to combine with the internal carotid Diagnosis and treatment of arterial cavernous sinus injury and traumatic aneurysm.