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首页> 外文期刊>Neurosurgery >Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression.
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Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression.

机译：人工颈动脉外压治疗海绵窦硬脑膜动静脉瘘。

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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 B), 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.
机译：目的：体外人工颈动脉压迫术是一种治疗海绵窦（CS）硬脑膜动静脉瘘（DAVF）的非侵入性方法。我们研究了一组CS-DAVF患者，以确定哪些因素可以通过压缩疗法完全缓解其临床症状并在磁共振血管造影（MRA）上关闭DAVF。方法：我们治疗23例CS-DAVF患者，无皮质静脉引流或近期因压迫疗法导致视力下降。所有患者均在治疗后1、3、6和12个月接受磁共振血管造影检查，并检查影像学表现，神经系统症状和症状改善方式。结果：在A组（n = 8）中，通过手动颈动脉加压获得了完全的分辨率。在其他15名患者（B组）中，未获得完全的解决。 B组表现出明显较高的眼压和症状发作与压迫治疗之间的间隔明显更长。在A组中，静脉血经眶上静脉伴或不伴有下睑窦窦。在开始治疗后的4.1个月内关闭了CS-DAVF。在三例患者中，症状改善稳步并逐渐进行。其他五名完全缓解的患者在开始治疗后的2至4个月经历了症状的短暂恶化，症状缓解在4至7个月内发生。结论：我们确定眼压降低，症状发作和压迫治疗之间的时间间隔较短，仅通过眶上静脉进行静脉引流而不涉及下睑窦的介入是我们CS-DAVF患者通过人工颈动脉完全解决的因素压缩可能。

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