特発性内頚動脈海綿静脈洞瘻の病態生理と治療方針

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Thirteen cases with spontaneous carotid-cavernous fistula found in our clinic during the last 5 years were analyzed.The age ranged from 24 to 74 years, and 12 were women.Initial symptoms were diplopia in 3 cases, severe orbital pain or headache with nausea and vomiting in 3 cases,dull pain around the orbit in 3 cases, red eye in 2 cases and tinnitus in 2 cases.Sings and symptoms at admission were conjuctival injection in 10 cases, chemosis in 5 cases, exophthalmos ranging from 2 to 9 mm, in 10 cases, bruit in 7 cases, disturbance of ocular movement in 7 cases, impairment of visual acuity in 4 cases, orbital pain or headache in 6 cases and tinnitus in 8 cases.Angiograms showed that in all cases dural branches of the internal carotid artery were contributors to the shunt and in at least 5 cases branches of external carotid artery were also contributors.There were positive correlation between angiographic findings and certain signs and symptoms.In all 3 cases with prominent venous drainage, disturbance of visual acuity and ocular movement were noticed.In another 10 cases, disturbance of visual acuity and ocular movements were found in one case and 4 cases, respectively. Furthermore, in 10 cases with posterior venous drainage via the inferior petrosal sinus, 8 cases complainted of tinnitus, but other 3 cases without showing posterior drainage, did not complain of tinnitus.Cerebral hemodynamic study was performed in 8 cases. In 7 cases rCBF values were normal and the relative shunt rate was small (10〜23%). In another one case rCBF could not be measured because the shunt rate of the affected internal carotid artery was 100%. These results coincided with the angiographic findings.Twelve cases were not operated on and follow-up study ranging from 9 months to 5.2 years were carried out.Clinical symptoms were alleviated in 4 cases and completely disappeared in 8 cases. The follow-up angiography in the latter 3 cases showed disappearance of the shunt.Consequently, in cases with small blood deprivation through the shunt and mild clinical symptoms, conservative treatment is recommended unless exacerbation is not noticed.
日本脳神経外科学会の論文
1978-06-15

特発性内頚動脈海綿静脈洞瘻の病態生理と治療方針

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