Clinical Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
Acta Neurochir (Wien). 2009 Oct;151(10):1301-4. doi: 10.1007/s00701-009-0251-3. Epub 2009 May 26.
Post-traumatic fistulas between the middle meningeal artery and the cranial venous system are extremely rare. We describe clinical presentation and successful endovascular management of a case of post-traumatic fistula between the middle meningeal artery and the sphenoparietal sinus.
A 53-year-old man was admitted with multiple brain contusions and a temporoparietal fracture after a head trauma. On day 3 after trauma he developed unilateral signs of a cavernous sinus syndrome. Digital subtraction angiography showed a fistula between the middle meningeal artery and the sphenoparietal sinus.
The fistula was occluded by endovascular coil embolization, resulting in complete remission of the clinical symptoms.
A high index of suspicion is necessary to detect subtle signs of venous congestion of the cavernous sinus in an intubated patient. Angiography is the diagnostic modality of choice and should include the selective investigation of the external carotid artery vascular territory. Endovascular therapy provides minimal invasive and definitive treatment of this rare condition.
外伤性大脑中动脉与颅静脉系统之间的瘘管极为罕见。我们描述了一例外伤性大脑中动脉与蝶顶窦之间瘘管的临床表现和成功的血管内治疗。
一名 53 岁男性因头部外伤后多发性脑挫裂伤和颞顶骨骨折入院。外伤后第 3 天，他出现单侧海绵窦综合征的体征。数字减影血管造影显示大脑中动脉和蝶顶窦之间存在瘘管。
经血管内线圈栓塞闭塞瘘管，使临床症状完全缓解。
对于插管患者，需要高度怀疑是否存在海绵窦静脉淤血的细微征象。血管造影是首选的诊断方法，应包括对外颈动脉血管区域的选择性检查。血管内治疗为这种罕见疾病提供了微创和确定性的治疗。
