脈絡膜剝離を合併し血管内治療が著効した頸動脈海綿静脈洞瘻（CCF）の1例

Intravascular neurosurgery was effective in a case of carotid cavernous fistula with choroidal detachment

　目的：脈絡膜剝離，浅前房，近視化を併発した頸動脈海綿静脈洞瘻症例の報告。症例：66歳女性が3週前からの眼球運動障害，眼球突出，結膜血管の蛇行と拡張，眼圧上昇で紹介受診した。矯正視力は右0.7，左0.3で，左眼に脈絡膜剝離，浅前房，近視化，動眼・滑車神経麻痺があった。血管造影で狭義の頸動脈海綿静脈洞瘻はなく，副硬膜動脈と上眼静脈との間に瘻形成が証明された。血管内治療が奏効し眼症状はほとんど消失した。結論：頸動脈海綿静脈洞瘻により，脈絡膜剝離，浅前房，近視化が発症することがある。海綿静脈洞を介さないため外転神経麻痺がなく，血流が直接短絡したことでうっ血が強く脈絡膜剝離が生じたと解釈される。

　Purpose：To describe a case of carotid cavernous fistula with choroidal detachment. Case and Findings：A 66-year-old female presented with ocular motility disorders,proptosis,hyperemia,elevated intraocular pressure,and impaired visual acuity since 3 weeks before. Her corrected visual acuity was 0.7 right and 0.3 left. Her right eye showed choroidal detachment,shallow anterior chamber,myopia,oculomotor and trochlear nerve palsy. Cerebral angiography showed fistula between the meningeal artery and superior ophthlmic vein. Endovascular treatment induced improvements of ocular manifestations. Conclusion：Carotid cavernous fistula may induce choroidal detachment,shallow anterior chamber and myopia. Sparing of the carotid cavernous sinus in the present case seems to have been the cause of absence of abducens palsy. Ocular congestion and choroidal detachment appear to have been due to involvement of superior ophthalmic artery.