Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression
Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression
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DOI：
10.1227/01.neu.0000249274.49192.3b
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发表时间：
2007-02-01
期刊：
影响因子：
4.8
通讯作者：
Kuratsu, Jun-ichi
中科院分区：
文献类型：
--
作者：
Kai, Yutaka;Hamada, Jun-ichiro;Kuratsu, Jun-ichi
目的：颈动脉外压迫是治疗海绵窦硬脑膜动静脉瘘的一种无创方法。我们研究了一组CS-DAVF患者，以确定哪些因素使他们的临床症状完全缓解，并通过压迫疗法在磁共振血管造影（MRA）上关闭DAVF possibly.METHODS：我们治疗了23例CS-DAVF患者，没有皮质静脉引流或最近视力下降的压迫疗法。所有随访的磁共振血管造影在1，3，6，和12个月后治疗和特点的影像学检查结果，他们的神经症状，症状改善的模式进行了examined.Results：在A组（n = 8），完全分辨率是通过手动颈动脉压迫。在其他15例患者（第13组）中，未获得完全缓解。B组表现出明显更高的眼压和症状发作与压迫治疗之间的明显更长的时间间隔。A组经上级眶静脉引流，伴或不伴岩下窦受累。CS-DAVF在治疗开始后4.1个月内闭合。在3例患者中，症状改善稳步渐进。其他5例完全缓解的患者在治疗开始后2至4个月出现短暂的症状恶化，症状在4至7个月内缓解。我们发现眼压较低，症状发作和压迫治疗之间的间隔较短，静脉引流仅通过上级眶静脉，不涉及岩下窦作为我们的CS的因素-通过手动颈动脉压迫完全缓解DAVF的患者。
OBJECTIVE: External manual carotid compression is a noninvasive method to treat cavernous sinus (CS) dural arteriovenous fistulae (DAVF). We studied a group of patients with CS-DAVF to identify what factors made complete resolution of their clinical symptoms and closure of the DAVF on magnetic resonance angiography (MRA) by compression therapy possible.METHODS: We treated 23 patients with CS-DAVF without cortical venous drainage or a recent decline in visual acuity by compression therapy. All were followed up by magnetic resonance angiography at 1, 3, 6, and 12 months after treatment and the characteristics of the imaging findings, their neurological symptoms, and the patterns of symptom improvement were examined.RESULTS: In Group A (n = 8), complete resolution was achieved by manual carotid compression. In the other 15 patients (Group 13), complete resolution was not obtained. Group B manifested significantly higher ocular pressure and a significantly longer interval between symptom onset and compression treatment. In Group A, venous drainage was via the superior orbital vein with or without involvement of the inferior petrosal sinus. Closure of the CS-DAVF occurred within 4.1 months after the start of treatment. In three patients, symptom improvement progressed steadily and gradually. The other five patients with complete resolution experienced transient worsening of their symptoms at 2 to 4 months after the start of treatment and symptom resolution occurred within 4 to 7 months.CONCLUSION: We identified lower ocular pressure, a shorter interval between symptom onset and compression treatment, and venous drainage solely via the superior orbital vein without involvement of the inferior petrosal sinus as the factors in our CS-DAVF patients that made complete resolution by manual carotid compression possible.