Ophthalmic Manifestations of Intracranial Dural Arteriovenous Fistula-Report of Four Cases

顱內硬腦膜動靜脈瘻管之眼科學表現－四個臨床病例報告

王宗仁(Tsung-Jen Wang) ； 周介仁(Jieh-Ren Jou) ； 翁林仲(Lin-Chung Woung) ； 施永豐(Yung-Feng Shih) ； 林隆光(Luke L-K Lin)

《慈濟醫學雜誌》 17卷2期 (2005/02) Pp. 93-97

https://doi.org/10.6440/TZUCMJ.200502.0093

摘要

目的：顱內硬腦膜動靜脈瘻管約占顱內動靜脈病灶的10%到15%，部分顱內硬腦膜動靜脈瘻管會造成眼部症狀，包括突眼、複視、鞏膜上靜脈曲張、眼球周圍腫脹、眼外肌運動受限、視野缺損及視乳突水腫。材料與方法：我們檢視過去三年四個顱內硬腦膜動靜脈瘻管併有眼科學表現之病例，顱內硬腦膜動靜脈瘻管之診斷是經由影像學檢查如核磁共振造影、核磁共振血管攝影、腦部血管攝影等所確定診斷。結果：三位為男性，一位為女性。根據Cognard分類，四個病例分別為typeⅠ, typeⅡa, typeⅡa+b及typeⅢ。起始表現包括頭痛、複視、突眼、鞏膜上靜脈曲張、眼球周圍腫脹、視野缺損及視乳突水腫。其中有三個病人接受經動脈栓塞，在經過動脈栓塞後，眼科症狀皆有改善。結論：顱內硬腦膜動靜脈瘻管可能會造成眼科方面的症狀並做為起始表現，這些症狀一般認為是反應上矢狀竇的靜脈高壓以致影響正常的靜脈回流，經動脈栓塞可做為有效關閉動靜脈瘻管的處置，進一步可以恢復上矢狀竇的功能及改善眼科方面症狀。

關鍵字

顱內硬腦膜動靜脈瘻管 ； 經動脈栓塞 ； 鞏膜上靜脈曲張

並列摘要

Objective: Intracranial dural arteriovenous fistulas (AVFs) account for 10%-15% of all intracranial arteriovenous lesions. Some dural AVFs produce ocular symptoms include proptosis, diplopia, episcieral venous engorgement, periorbital swelling, extraocular muscle limitation, visual field defect, and papillaedema. Materials and Methods: We reviewed four patients who had dural AVFs with ophthalmic manifestations in the past three years (2000 November to 2003 October.) The diagnosis of dural AVF was confirmed by image studies, such as magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and cerebral angiography. Results: There were three men and one woman. According to Cognard's classification, there were four types: type Ⅰ, type Ⅱa, type Ⅱa+b, and type Ⅲ. Symptoms at initial presentation included headache, diplopia, proptosis, episcieral vein engorgement, periorbital swelling, visual field defect, and papillaedema. Three patients received transarterial embolization (TAE) in our hospital. Improvement in ophthalmic symptoms and signs was noted after TAE treatment, although multiple interventions were required. Conclusions: Dural AVFs can produce various ocular symptoms and signs at their initial manifestation. The symptoms are believed to reflect venous hypertension in the superior sagital sinus, resulting from the shunted flow, which interferes with normal venous drainage. Transarterial embolization can be an effective treatment to close the fistula, restore sinus function and improve ocular symptoms.

並列關鍵字

dural arteriovenous fistula ； transarterial embolization ； episcleral vein engorgement