特発性頸動脈海綿静脈洞瘻の4症例

Four cases of spontaneous fistula of carotid cavernous sinus

　内頸動脈瘤破裂1例と硬膜動静脈奇形3例の特発性頸動脈海綿静脈洞瘻を経験した。

　内頸動脈瘤破裂の1例は，外傷性類似の著しい眼痛，眼球突出，眼球運動障害，血管雑音等を呈したが，detachable balloon法による瘻孔の閉塞にて急速に症状の改善をみた。

　硬膜動静脈奇形のうち，緑内障発作様の眼圧上昇と視力低下を起こした1例と，眼痛と眼球運動障害の強い1例に対し，超選択的カテーテル法による流入動脈塞栓術を行い症状の改善をみた。臨床症状の軽微であった硬膜動静脈奇形の1例は，一過性の軽度眼圧上昇を呈したものの徐々に軽快し，約3か月後に臨床症状は自然消失した。

We observed 4 cases of spontaneous fistula of the carotid cavernous sinus. The fistula was caused by rupture of aneurysm in the intracavernous portion of the carotid artery in one case. Dural arter-iovenous malformations (AVM) were causatively involved in the other 3 cases.

The case with rupture of aneurysm presented with severe eye pain, exophthalmos, ophthalmo-plegia and bruit. Cure was attained with occlusion of the fistula with detachable balloon. The 2 cases with AVM were successfully treated by emboliza-tion of dural feeders of the external carotid artery with small particles. In a third case with dural AVM, the lesion resolved spontaneously within 3 months.