以双侧外展神经麻痹为表现的颈动脉海绵窦瘘1例报告OA

Objective To investigate the diagnostic approach and endovascular treatment strategies for atypical clinical presentations of carotid-cavernous fistula(CCF)patients with bilateral abducens nerve palsy as the initial symptom.Methods The clinical data of 1 patient with CCF was analyzed and organized,with detailed review of clinical characteristics,auxiliary examinations(cerebral artery CTA,DSA,orbital MRI,cerebrospinal fluid analysis,etc.),and treatment course.Results The patient presented with persistent horizontal diplopia accompanied by headache and dizziness.Cerebral artery CTA suggested multiple tortuous vascular shadows in the cavernous sinus segment during the arterial phase bilaterally,with visualization of bilateral ophthalmic veins,raising suspicion of an arteriovenous fistula.Orbital MRI revealed thickening,abnormal signal,and enhancement of the bilateral lateral rectus,inferior rectus,superior rectus,and superior oblique muscles.DSA revealed that the bilateral external carotid arteries supplied blood to the skull base through a hazy vascular network,which then drained into the cavernous sinus region.The bilateral ophthalmic veins were enlarged,and venous drainage occurred via the inferior petrosal sinus to the sagittal sinus and the right sigmoid sinus.Intraoperative diagnosis confirmed a carotid-cavernous fistula.After undergoing endovascular embolization for the carotid-cavernous fistula,the patient's horizontal diplopia,headache,and dizziness were alleviated.Conclusion Spontaneous CCF is a rare cause of bilateral abducens nerve palsy.When elderly patients present with unexplained bilateral abducens nerve palsy,CCF should be considered.In such cases,performing CTA and even DSA is necessary.Treatment should be determined based on the severity of clinical symptoms and DSA findings,ranging from conservative management to surgical intervention.Currently,the mainstream surgical approach is endovascular therapy.