背景:海绵窦硬脑膜动静脉瘘(CSDAVF)是放射科医生在职业生涯中遇到的罕见疾病。我们的目的是描述这种情况的临床和放射学特征,并提供管理工作流。
方法:在我们的回顾性研究中,我们研究了2007年1月至2020年8月的27例CSDAVF患者。直接海绵窦AVF患者和日期不完整的患者被排除在外。收集和分析临床和放射学数据。
结果:14例患者保守治疗,自发消退,13例患者行血管内介入治疗。在干预组中,7例患者在影像学检查中出现颅内反流,6例患者出现临床恶化,因此需要干预。临床上,在我们的病人中,21岁有突起,20人患有结膜充血症,18有眼外运动受限,13人眼压升高,11人发生了化疗,十个有眼痛,九有眼部瘀伤,八人头痛,六人视力恶化。放射学上,眼上静脉血栓形成和CSDAVF的自发消退之间存在一致性,与接受干预的人相比。尽管在CSDAVF的放射学成像中流量减少或对比度停滞,但仍观察到眼部症状的矛盾增加。
结论:在我们的研究中,52%的CSDAVF自发关闭。CSDAVF患者眼部症状的恶化可能也反映了自发性进行性闭塞,它需要动态血管成像来检查静脉流出的状态。患有皮质静脉回流或视力恶化的CSDAVF患者需要更紧急的(血管内)治疗。
BACKGROUND: Cavernous sinus dural arteriovenous fistula (CSDAVF) is a rare condition that radiologists would encounter in their careers. We aim to describe the clinical and radiological characteristics of this condition, and to provide a management workflow.
METHODS: In our retrospective study, we studied 27 patients with CSDAVF from January 2007 to August 2020. Patients with direct cavernous sinus AVFs and patients with incomplete date were excluded. Clinical and radiological data were collected and analyzed.
RESULTS: Fourteen patients were conservatively treated with spontaneous resolution while 13 patients had endovascular intervention performed. In the intervention group, seven patients had intra-cranial reflux seen on radiological imaging and six patients had clinical deterioration, hence requiring intervention. Clinically, among our patients, 21 had proptosis, 20 had conjunctiva hyperaemia, 18 had extraocular movement limitation, 13 had raised intraocular pressure, 11 had chemosis, ten had ocular pain, nine had ocular bruit, eight had headache and six had worsening visual acuity. Radiologically, a concurrence was seen between superior ophthalmic vein thrombosis and spontaneous resolution of the CSDAVF, as compared to those who underwent intervention. A paradoxical increase of ocular symptoms was seen despite a decrease of flow or stagnation of contrast in radiological imaging of CSDAVF.
CONCLUSIONS: In our study, 52% of CSDAVF closed spontaneously. As deterioration of ocular symptoms in patients with CSDAVF might also reflect spontaneous progressive occlusion, it warrants dynamic vascular imaging to check the status of venous outflow. Patients with CSDAVF with corticovenous reflux or deterioration of visual acuity need more urgent (endovascular) treatment.