■颈动脉海绵窦瘘(CCF)代表一组罕见的,颈动脉系统和海绵窦(CS)之间的异常动静脉通信。CCF通常会产生与CS压力增加和眼睛的逆行静脉引流有关的眼科症状。尽管血管内闭塞仍然是有症状或高危CCF的首选治疗方法,这些病变的大多数数据仅限于很小,单中心系列。因此,我们进行了一项系统回顾和荟萃分析,评估CCF的血管内闭塞,以确定临床结局的差异,瘘管类型,和治疗范式。
■使用PubMed对截至2023年3月发表的所有讨论CCF血管内治疗的研究进行了回顾性回顾,Scopus,WebofScience,和Embase数据库。共有36项研究纳入荟萃分析。使用Stata软件版本14提取和分析来自所选文章的数据。
■1494例患者被纳入。55.08%为女性,队列的平均年龄为48.10岁。共有1516个瘘管接受了血管内治疗,其中48.05%为直接,51.95%为间接。87.17%的CCF继发于已知的创伤,而10.18%是自发的。最常见的症状是89%的眼球突出(95%CI:78.0-100.0;I2=75.7%),84%的化疗(95%CI:79.0-88.0;I2=91.6%),79%突起(95%CI:72.0-86.0;I2=91.8%),75.0%的瘀伤(95%CI:67.0-82.0;I2=90.7%),56%复视(95%CI:42.0-71.0;I2=92.3%),49%颅神经麻痹(95%CI:32.0-66.0;I2=95.1%),视觉下降39%(95%CI:32.0-45.0;I2=71.4%),32%耳鸣(95%CI:6.0-58.0;I2=96.7%),29%的眼内疼痛升高(95%CI:22.0-36.0;I2=0.0%),31%眼眶或眶前疼痛(95%CI:14.0-48.0;I2=89.9%)和24%头痛(95%CI:13.0-34.0;I2=74.98%)。线圈,气球,和支架分别是三种最常用的栓塞方法。在68%的病例中发现瘘管立即完全闭塞,在82%的病例中发现完全缓解。CCF的复发仅发生在35%的患者中。7%的病例在治疗后观察到颅神经麻痹。
■眼球突出,化疗,突增,瘀伤,颅神经麻痹,复视,眼眶和眶周疼痛,耳鸣,眼内压升高,视力下降和头痛是CCF最常见的临床表现.大多数血管内治疗涉及卷绕,球囊和玛瑙以及高比例的CCF患者随着临床症状的改善而完全缓解。
UNASSIGNED: Carotid-cavernous fistulas (CCFs) represent a group of rare, abnormal arteriovenous communications between the carotid arterial system and the cavernous sinuses (CS). CCFs often produce ophthalmologic symptoms related to increased CS pressures and retrograde venous drainage of the eye. Although endovascular occlusion remains the preferred treatment for symptomatic or high-risk CCFs, most of the data for these lesions is limited to small, single-center series. As such, we performed a systematic review and meta-analysis evaluating endovascular occlusions of CCFs to determine any differences in clinical outcomes based on presentation, fistula type, and treatment paradigm.
UNASSIGNED: A retrospective review of all studies discussing the endovascular treatment of CCFs published through March 2023 was conducted using PubMed, Scopus, Web of Science, and Embase databases. A total of 36 studies were included in the meta-analysis. Data from the selected articles were extracted and analyzed using Stata software version 14.
UNASSIGNED: 1494 patients were included. 55.08% were female and the mean age of the cohort was 48.10 years. A total number of 1516 fistulas underwent endovascular treatment, 48.05% of which were direct and 51.95% of which were indirect. 87.17% of CCFs were secondary to a known trauma while 10.18% were spontaneous. The most common presenting symptoms were 89% exophthalmos (95% CI: 78.0-100.0; I2 = 75.7%), 84%
chemosis (95% CI: 79.0-88.0; I2 = 91.6%), 79% proptosis (95% CI: 72.0-86.0; I2 = 91.8%), 75.0% bruits (95% CI: 67.0-82.0; I2 = 90.7%), 56% diplopia (95% CI: 42.0-71.0; I2 = 92.3%), 49% cranial nerve palsy (95% CI: 32.0-66.0; I2 = 95.1%), 39% visual decline (95% CI: 32.0-45.0; I2 = 71.4%), 32% tinnitus (95% CI: 6.0-58.0; I2 = 96.7%), 29% elevated intraocular pain (95% CI: 22.0-36.0; I2 = 0.0%), 31% orbital or pre-orbital pain (95% CI: 14.0-48.0; I2 = 89.9%) and 24% headache (95% CI: 13.0-34.0; I2 = 74.98%). Coils, balloons, and stents were the three most used embolization methods respectively. Immediate complete occlusion of the fistula was seen in 68% of cases and complete remission was seen in 82%. Recurrence of CCF occurred in only 35% of the patients. Cranial nerve paralysis after treatment was observed in 7% of the cases.
UNASSIGNED: Exophthalmos,
Chemosis, proptosis, bruits, cranial nerve palsy, diplopia, orbital and periorbital pain, tinnitus, elevated intraocular pressure, visual decline and headache are the most common clinical manifestations of CCFs. The majority of endovascular treatments involved coiling, balloons and onyx and a high percentage of CCF patients experienced complete remission with the improvement of their clinical symptoms.