颈内动脉海绵窦瘘课件.pptx

1、context 1809 Travers 1930 Brooks 1933 Hamby 1968 Arutiunov 1971 Serbinenko 1975 DebrunAnatomy of cavernous sinusVenous drainage of cavernous sinusConclusion 1 Anatomy “An artery”Internal carotid artery(ICA)颈内动脉“Four nerves”动眼神经、滑车神经、展神经、三叉 神经眼支、上颌支“Venous drainage”眼上静脉、眼下静脉、蝶顶窦静脉、外侧裂静脉、基底静脉等What is

2、CCF?Definition:颈动脉海绵窦瘘（carotid cavernous sinus Fistula,CCF）是指海绵窦段的颈内动脉及其分支破裂，使之与海绵窦形成动静脉的异常交通，引起的神经眼科综合征。Pathophysiological mechanisms of CCFBleeding神经功能障碍Pathophysiological mechanisms of CCF 静脉回流障碍Conclusion 2 Pathophysiological ICA split （trauma is the primary cause）（颈动脉破裂）Formed arteriovenous fis

3、tula Drainage obstacles（回流障碍）Neurological dysfunction To consider or Questions 1、Clinical Feature？CCFs Clinical Feature 搏动性眼球突出 眼球表面血管怒张、“红眼”血管杂音和震颤 结膜水肿、眼睑水肿 高眼压 头痛 眼外肌麻痹 眼底改变、视力下降 额面部感觉障碍Imaging performance B超CDFI CT MRI DSA1809 Travers 结扎颈总动脉How do we treat it?Ischemia（缺血）Venous drainage of caver

4、nous sinus1975 Debrun 改进球囊栓塞技术Ischemia（缺血）Conclusion 1 AnatomyAnatomy of cavernous sinusICA split（trauma is the primary cause）Definition:Anatomy of cavernous sinus1933 HambyICA split （trauma is the primary cause）1933 Hamby 结扎颈内动脉、孤立CCFDSA 血管造影是诊断CCF最可靠的方法，也称“金标准”。纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症 Formed

5、 arteriovenous fistulaInternal carotid artery(ICA)颈内动脉颈动脉海绵窦瘘影像学特征 眼上静脉扩张 海绵窦膨大 眼外肌增粗 眼球突出 眼眶软组织肿胀 DSAl DSA 血管造影是诊断CCF最可靠的方法，也称“金标准”。选择性动脉造影可显示动脉期海绵窦及眼上静脉显影，确定瘘口位置和大小，并为治疗提供依据。How do we treat it?理想的治疗方法是可靠地封闭瘘口，同时保持颈内动脉的通畅TREATMENT 1809 Travers 结扎颈总动脉 1930 Brooks 肌肉条栓塞 1933 Hamby 结扎颈内动脉、孤立CCF 1968 A

6、rutiunov“放风筝”1971 Serbinenko 首创球囊栓塞 1975 Debrun 改进球囊栓塞技术TREATMENT介入治疗是目前治疗CCF最理想的方法，居于其他方法不可替代的地位For more information,please listen to the next decompositionEstimate of treatment 治疗目的：消除颅内血管杂音，使突眼回缩，防止视力进一步下降 纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症Conclusion 3 CCFICA split（trauma is the primary cause）Bleeding

7、（出血）Ischemia（缺血）Formed arteriovenous fistula Drainage obstacles（回流障碍）Neurological dysfunction 临床表现：颅内出血，鼻出血，脑梗塞搏动性突眼，颅内杂音，“眼征”眼球运动障碍，视力下降，额面部感觉障碍Homework 了解CCF的“前世今生”（自学）context 1809 Travers 1930 Brooks 1933 Hamby 1968 Arutiunov 1971 Serbinenko 1975 DebrunPathophysiological mechanisms of CCF颈动脉海绵窦瘘影

8、像学特征眼球运动障碍，视力下降，额面部感觉障碍Drainage obstacles（回流障碍）1809 Travers眼球表面血管怒张、“红眼”Conclusion 3 CCF To consider or QuestionsFor more information,please listen to the next decomposition动眼神经、滑车神经、展神经、三叉1933 Hamby 结扎颈内动脉、孤立CCF1930 BrooksHow do we treat it?“An artery”1975 Debrun Formed arteriovenous fistula纠正脑盗血，防

9、止脑缺血，预防脑出血及严重鼻出血等严重并发症神经眼支、上颌支Anatomy of cavernous sinusPathophysiological mechanisms of CCF 静脉回流障碍To consider or Questions 1、Clinical Feature？Estimate of treatment 治疗目的：消除颅内血管杂音，使突眼回缩，防止视力进一步下降 纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症1933 Hamby 结扎颈内动脉、孤立CCF1968 ArutiunovPathophysiological mechanisms of CCF动眼神

10、经、滑车神经、展神经、三叉Ischemia（缺血）ICA split（trauma is the primary cause）眼球运动障碍，视力下降，额面部感觉障碍（颈动脉破裂）颈动脉海绵窦瘘影像学特征To consider or Questions 1933 HambyDSA 血管造影是诊断CCF最可靠的方法，也称“金标准”。Conclusion 1 AnatomyInternal carotid artery(ICA)颈内动脉Venous drainage of cavernous sinusPathophysiological mechanisms of CCFConclusion 3

11、CCFCCFs Clinical Feature1930 BrooksIschemia（缺血）外侧裂静脉、基底静脉等ICA split（trauma is the primary cause）Bleeding（出血）1971 Serbinenko 首创球囊栓塞To consider or QuestionsICA split（trauma is the primary cause）1930 BrooksBleeding（出血）1、Clinical Feature？Neurological dysfunctionEstimate of treatment理想的治疗方法是可靠地封闭瘘口，同时保持颈

12、内动脉的通畅Ischemia（缺血）纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症Estimate of treatmentTo consider or Questions眼球运动障碍，视力下降，额面部感觉障碍Formed arteriovenous fistula纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症Conclusion 1 AnatomyAnatomy of cavernous sinusDefinition:纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症动眼神经、滑车神经、展神经、三叉B

13、leeding（出血）Conclusion 1 Anatomy动眼神经、滑车神经、展神经、三叉1933 Hamby 1975 DebrunFor more information,please listen to the next decomposition1933 Hamby1933 Hamby纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症To consider or Questions1975 Debrun1809 TraversTo consider or QuestionsFormed arteriovenous fistula1933 HambyWhat is CCF?H

14、ow do we treat it?1971 SerbinenkoVenous drainage of cavernous sinus1975 Debrun1975 Debrun1933 HambyTo consider or QuestionsDrainage obstacles（回流障碍）（颈动脉破裂）动眼神经、滑车神经、展神经、三叉1933 HambyICA split（trauma is the primary cause）1968 Arutiunov1930 BrooksTo consider or Questions1933 Hamby动眼神经、滑车神经、展神经、三叉眼球运动障碍，

15、视力下降，额面部感觉障碍Definition:Anatomy of cavernous sinusConclusion 3 CCF1930 BrooksDefinition:CCFs Clinical Feature“An artery”What is CCF?（颈动脉破裂）Pathophysiological mechanisms of CCF1930 BrooksFor more information,please listen to the next decompositionConclusion 1 AnatomyICA split （trauma is the primary cause）纠正脑盗血，防止脑缺血，预防脑出血及严重鼻出血等严重并发症1975 DebrunConclusion 1 Anatomy1933 HambyPathophysiological mechanisms of CCFInternal carotid artery(ICA)颈内动脉1933 Hamby1930 BrooksHomework 了解CCF的“前世今生”（自学）