경막동맥해면정맥동루의 임상양상과 색전술의 치료효과
The Clinical Characteristics and Endovascular Management Outcomes of Dural Carotid Cavernous Fistulas
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목적: 경막동맥해면정맥동루의 임상양상과 색전술의 치료효과를 보고하고자 하였다. 대상과 방법: 뇌혈관조영술을 통하여 확진된 경막동맥해면정맥동루 환자 14명 15안을 대상으로 안과적 증상, 징후, 동반되는 전신이상 을 조사하였고, 색전술을 시행한 환자에서 결과를 의무기록을 바탕으로 후향적으로 분석하였다. 결과: 평균연령은 50.6 ± 14.2세로 남:여 비는 4:10이었다. 우안 7안, 좌안 8안이었고, 2명에서 고혈압이 동반되었다. 주증상으로 복시 와 충혈, 안구통증, 안구돌출을 호소하였으며 그 외 눈꺼풀처짐, 이명이 있었다. 뇌혈관조영술에서 Barrow type D가 12안(80%)로 가장 많은 비율을 차지하였고, 색전술은 13안에서 평균 1회 시행되었다. 색전술을 시행한 경우 12안에서 평균 4.5개월 이내에 임상증상이 개선되었고, 치료와 연관된 합병증은 없었다. 결론: 중년의 여성이 지속되는 충혈이나 갑자기 발생한 복시를 주소로 내원하는 경우 경막동맥해면정맥동루를 의심하고 감별하는 것이 필요하며, 색전술은 덜 침습적이면서, 1회 성공률이 높은 효과적인 치료로 사료된다.
Abstract
Purpose: To describe the clinical characteristics and endovascular management outcomes of Dural carotid cavernous sinus fistula (Dural CCF). Methods: Ocular symptoms, signs, and complications of 15 eyes from 14 patients confirmed with Dural CCF by angiography were examined. The medical records of patients who underwent endovascular management were analyzed retrospectively. Results: The mean age of the patients was 50.6 ± 14.2 years; 4 were men and 10 were women. The eye consisted of 7 right eyes and 8 left eyes. Two eyes were of hypertension patients. The chief clinical symptoms on the first visit were diplopia, injection, ocular pain, proptosis, ptosis, and tinnitus. On cerebral angiography, Barrow Type D was the most common consisting of 12 cases (80%). Endovascular embolization was performed in 13 eyes and the average number of times received was 1. Signs and symptoms improved over a mean of 4.5 months of clinical follow-up in 12 eyes. There were no ocular complications related to endovascular embolization. Conclusions: Dural CCF should be suspected in a middle-aged woman with injection or diplopia. Endovascular embolization is considered minimally invasive and highly successful for the treatment of Dural CCF.
참고문헌 (33)
- Grove AS Jr, "The dural shunt syndrome,In Pathophysiology and clinical course", Ophthalmology, 90, pp.31~44 (1984)
- Lee HJ, "A case of dural carotid cavernous sinus fistula associated with ophthalmic manifestations", J Korean Ophthalmol Soc, 37, pp.1544~1549 (1996)
- Phelps CD, "The diagnosis and prognosis of atypical carotid-cavernous fistula", Am J Ophthalmol, 93, pp.423~436 (1982)
- Stiebel Kalish H, "Bilateral orbital signs predict cortical venous drainage in cavernous sinus dural AVMs", Neurology, 58, pp.1521~1524 (2002)
- Stiebel Kalish H, "Cavernous sinus dural arteriovenous malformations patterns of venous drainage are relate to clinical signs and symptoms", Ophthalmology, 109, pp.1685~1691 (2002)
- Eggenberger E, "A bruital headache and double vision", Surv Ophthalmol, 45, pp.147~153 (2000)
- Procope JA, "Dural cavernous sinus fistula: an unusual presentation", J Natl Med Assoc, 86, pp.363~364 (1994)
- 임남기, "경동맥해면정맥동루의 상안정맥노출에 의한 코일 색전술", 대한안과학회지, 47(7), pp.1141~1148 (2006), 대한안과학회
- Barrow DL, "Classification and treatment of spontaneous carotid cavernous sinus fistulas", J Neurosurg, 62, pp.248~256 (1985)
- Lie TA, "Congenital anomalies of the carotid arteries, Including the carotid-basilar and carotid vertebral anastomoses", pp.1968~ (2005), Excerpta Medica
- Houser OW, "Arteriovenous malformation affecting the transverse dural venous sinus an acquired lesion", Mayo Clin Proc, 54, pp.651~661 (1979)
- Schoolman A, "Bilateral spontaneous carotid cavernous fistulae in Ehlers Danlos syndrome", J Neurosurg, 26, pp.82~86 (1967)
- Haugen OH, "Bilateral non traumatic carotid cavernous sinus fistula with spontaneous closure", Acta Ophthalmol, 68, pp.743~747 (1990)
- Mironov A, "Dural arteriovenous fistula of the inferior petrosal sinus producing contralateral exophthalmus", Neuroradiology, 36, pp.619~621 (1994)
- Martin TJ, "Left dural to right cavernous sinus fistula", A case report. J Neuroophthalmol, 15, pp.31~35 (1995)
- Kurata A, "Spontaneous carotid cavernous fistulas with special reference to the influence of estradiol decrease", Neurol Res, 21, pp.631~639 (1999)
- Kim MS, "Clinical characteristics of dural arteriovenous fistula", J Clin Neurosci, 9, pp.147~155 (2002)
- Kurokawa T, "A case of dural carotid cavernous sinus fistula presenting contralateral eye symptoms", Folia Ophthalmol Jpn, 26, pp.318~323 (1995)
- Higashida RT, "Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions", Am J Roentgenol, 153, pp.577~582 (1989)
- Berthelsen B, "Treatment of direct carotid-cavernous fistulas with detachable balloons", Acta Radiol, 28, pp.683~691 (1987)
- Baek WH, "Treatment of traumatic carotid carvenous fistular using Debrun's latex detatchabel balloon", J Korean Neurosurgical Soc, 4, pp.773~777 (1985)
- Halbach VV, "Transvenous embolization of direct carotid cavernous fistulas", AJNR Am J Neuroradiol, 9, pp.741~747 (1988)
- Quiñones D, "Embolization of dural cavernous fistulas via superior ophthalmic vein approach", AJNR Am J Neuroradiol, 18, pp.921~928 (1997)
- Monsein LH, "Treatment of dural carotid cavernous fistulas via the superior ophthalmic vein", Am J Neuroradiol, 12, pp.435~439 (1991)
- Cheng KM, "Transvenous embolisation of dural carotid cavernous fistulas by multiple venous routes", Acta Neurochir, 145, pp.17~29 (2003)
- Chun GF, "Transvenous embolization of a direct carotid cavernous fistula through the pterygoid plexus", Am J Neuroradiol, 23, pp.1156~1159 (2002)
- Bellon RJ, "Percutaneous transfemoral embolization of an indirect carotid-cavernous fistula with cortical venous access to the cavernous sinus", J Neurosurg, 90, pp.959~963 (1999)
- Urtasun F, "Cerebral dural arteriovenous fistulas percutaneous transvenous embolization", Radiology, 199, pp.209~217 (1996)
- Joseph GJ, "Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses", Am J Neuroradiol, 19, pp.571~576 (1998)
- Roy D, "The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas", Neurosurgery, 40, pp.1133~1141 (1997)
- Kupersmith MJ, "Management of nontraumatic vascular shunts involving the cavernous sinus", Ophthalmology, 95, pp.121~130 (1988)
- Miller NR, "Treatment of carotid cavernous sinus fistulas using a superior ophthalmic vein approach", J Neurosurg, 83, pp.838~842 (1995)
- 김철, "경막동맥-해면정맥동루의 임상양상과 치료결과", 대한안과학회지, 44(7), pp.1~1474 (2003), 대한안과학회