特発性頸動脈海綿静脈洞瘻の長期追跡調査結果とそれに基づく治療方針

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Long-term follow-up results were analysed in 20 cases with spontaneous carotid-cavernous fistulas. The age of the patients ranged from 20 to 76 years and 10 cases were under 60 years. The modality of the onset of initial symptoms was acute in six cases and gradual in 14. Cervical carotid arteries were occluded in one case with severe neurological signs and symptoms and a high (100%) shunt rate from the affected internal carotid artery to the venous system. The other 19 cases were followed up from 13 months to 9 years 8 months without surgical treatment. Additional symptoms were noted in 15 cases during the follow-up period. The period from onset to peak of individual clinical pictures varied; within one month in seven cases, between one and 6 months in seven, and more than 6 months in five. The peak of the clinical pictures was usually recognized between one and 6 months in cases under 60 years of age and within one month or more than 6 months in cases over 60 years of age. Temporary reappearance of symptoms after their regression was noted within 2 months in four cases and 6 months in one. The regression of symptoms without reappearance for more than 6 months (6 months -6 years 10 months) was noted in 17 cases and marked improvement of symptoms was seen in one case during the follow-up period. The interval between the appearance and disappearance of symptoms in these 18 cases was as follows; within 6 months in four cases, between 6 months and one year in four, between one year and 2 years in four, and more than 2 years in six. The regression of symptoms was usually slow in cases under 60 years of age, in cases which showed slow progression of clinical pictures, and in cases with three draining veins. From these results, conservative treatment is recommended in cases with spontaneous carotidcavernous fistulas except in those with a very high shunt rate.
日本脳神経外科学会の論文
1983-10-15

特発性頸動脈海綿静脈洞瘻の長期追跡調査結果とそれに基づく治療方針

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