Kagawa K, Nishimura S, Seki K
Department of Neurosurgery, Kesennuma County Hospital, 184 Aza Tanaka, Kesennuma-city, Miyagi 988-0052, Japan.
No Shinkei Geka. 2001 May;29(5):457-63.
Cavernous sinus dural arteriovenous shunt (CdAVS) usually presents with exophthalmos, conjunctival chemosis, ophthalmoplegia, headache, bruit, or pulsatile tinnitus. Intracranial hemorrhage associated with CdAVS is rare. We describe a patient with CdAVS presenting with subarachnoid hemorrhage and acute subdural hematoma. A 65-year-old woman presented headache and temporary loss of consciousness and was transferred to our hospital. On admission, the patient was alert and complained of a left-sided temporal headache. There were no ocular symptoms. A CT scan revealed subarachnoid hemorrhage and left acute subdural hematoma. When we prepared for cerebral angiography, the patient presented loss of consciousness following sudden onset of severe headache. Urgent angiography revealed left CdAVS, which was fed by both the internal carotid artery and the external carotid artery and drained only into ipsilateral (left) vein of the sylvian fissure. Aneurysmal dilatation of the draining veins and leptomeningeal drainage were present. No cerebral aneurysms were detected. After the angiography, a CT scan showed enlarged subdural hematoma, so left fronto-temporo-parietal craniotomy was immediately performed. On opening the dura mater, arterial bleeding from Sylvian fissure appeared and was uncontrollable. Unfortunately, the patient died 3 days after the operation. We concluded that subarachnoid hemorrhage and subdural hematoma were due to the rupture of engorged cortical veins. Our case report suggests that CdAVS with angiographic findings such as aneurysmal dilatation of the draining veins and leptomeningeal drainage should be treated urgently because of the high risk of the life-threatening complications resulting from a surgically uncontrollable hemorrhage.
海绵窦硬脑膜动静脉瘘（CdAVS）通常表现为眼球突出、结膜水肿、眼球运动障碍、头痛、血管杂音或搏动性耳鸣。与CdAVS相关的颅内出血很少见。我们描述了一名患有CdAVS并出现蛛网膜下腔出血和急性硬膜下血肿的患者。一名65岁女性出现头痛和短暂意识丧失，被转诊至我院。入院时，患者神志清醒，主诉左侧颞部头痛。无眼部症状。CT扫描显示蛛网膜下腔出血和左侧急性硬膜下血肿。当我们准备进行脑血管造影时，患者在突然出现剧烈头痛后出现意识丧失。紧急血管造影显示左侧CdAVS，由颈内动脉和颈外动脉供血，仅引流至同侧（左侧）外侧裂静脉。引流静脉存在动脉瘤样扩张和软脑膜引流。未检测到脑动脉瘤。血管造影后，CT扫描显示硬膜下血肿增大，因此立即进行了左侧额颞顶开颅手术。打开硬脑膜后，外侧裂出现动脉出血且无法控制。不幸的是，患者术后3天死亡。我们得出结论，蛛网膜下腔出血和硬膜下血肿是由于充血的皮质静脉破裂所致。我们的病例报告表明，具有如引流静脉动脉瘤样扩张和软脑膜引流等血管造影表现的CdAVS应紧急治疗，因为手术无法控制的出血导致危及生命并发症的风险很高。
