Spontaneous Regression of Indirect Carotid-Cavernous Sinus Fistula

目的：報告兩例自行關閉且症狀緩解的間接型頸動脈海綿竇瘻管案例。方法：病例報告。結果：一名74歲的男性患有間接性頸動脈海綿竇瘻管，他沒有受傷的病史，臨床表現左眼突發性紅腫疼痛合併凸眼及完全眼肌麻痺，眼瞼呈現結膜嚴重充血水腫，眼壓升高，但聽診無雜音；眼眶部斷層掃描及核磁共振造影證實上眼靜脈鼓張合併懷疑眼窩偽腫瘤。由於懷疑合併眼窩偽腫瘤，我們使用大劑量類固醇脈衝治療，該頸動脈海綿海綿竇瘻管在距離初始眼部症狀19天瘺管自行關閉且症狀緩解。另一名29歲的女性亦患有間接性頸動脈海綿竇瘻管，她也沒有受傷的病史，臨床表現為右眼眼瞼腫脹，凸眼，角膜表層點狀破皮及眼壓升高。眼眶部斷層掃描及核磁共振造影皆證實間接性頸動脈海綿竇瘻管的存在。在發病後四個月，亦即第一次血管攝影後兩周，其頸動脈海綿竇瘻管自行關閉且症狀緩解。結論：雖然間接性頸動脈海綿竇瘻管有些會自行關閉，但是於就診後兩周這樣短時間內關閉的案例相當少見。類固醇、含碘的顯影劑、血管攝影的導管鞘的操作或許是促使我們這兩例間接性頸動脈海綿竇瘻管關閉的原因。

關鍵字

無資料

並列摘要

We report two cases of spontaneous regression of indirect carotidcavernous sinus fistula (CCF). A 74-year-old man presented with sudden onset of painful swelling without traumatic history in his left eye. Ocular examinations showed proptosis, ophthalmoplegia, marked lid edema with local heat, congested conjunctiva and chemosis, but no bruits in the left eye. Orbital CT and MRI demonstrated superior ophthalmic vein engorgement and suspected inflammation of orbits. Methylprednisolone pulse therapy had been used under suspicion of combined idiopathic orbital inflammation. His CCF got spontaneous regression in 19 days after his initial ocular symptom, 8 days after contrast CT. Another 29-year-old woman without traumatic history had progressively lid swelling in her right eye. Ocular examination revealed good vision, edematous eyelids, proptosis, superficial punctate keratitis, and elevated IOP in the right eye. Orbital CT and diagnostic angiography demonstrated indirect CCF. She had spontaneous regression of CCF 4 months after her initial ocular symptoms, and 2 weeks after diagnostic angiography. Although some of the indirect CCF could be spontaneously closed, corticosteroid, iodine contrast medium, and angiographic catheter manipulation may contribute to the closure in our cases.

並列關鍵字

Mesh Term ； angiographic catheter ； carotid-cavernous sinus fistula ； corticosteroid ； iodine contrast medium

國際替代計量

Spontaneous Regression of Indirect Carotid-Cavernous Sinus Fistula

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