Nishio Akimasa, Kawakami Taichiro, Mitsuhashi Yutaka, Hayasaki Koji, Kiyama Miki, Tada Yuichi, Ohata Kenji
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.
Neurol Med Chir (Tokyo). 2009 Dec;49(12):604-7. doi: 10.2176/nmc.49.604.
A 61-year-old woman was admitted for head injury after a traffic accident. Two months later, she developed abducens nerve palsy, chemosis, and pulsatile tinnitus. Right internal carotid angiography demonstrated a high flow direct carotid-cavernous fistula (CCF) at the C(5) portion with reflux into the superficial and deep sylvian veins, superior ophthalmic vein, superior petrosal sinus, and inferior petrosal sinus. Intravascular ultrasonography (IVUS) revealed a large fistula at the C(5) portion of the internal carotid artery (ICA). Coil embolization via transarterial and transvenous approaches under IVUS monitoring was performed. During the procedure, IVUS accurately detected protrusion of a coil into the parent ICA, and the parent artery could be preserved. IVUS monitoring is useful for embolization of direct CCF with coils.
一名61岁女性因交通事故导致头部受伤入院。两个月后，她出现展神经麻痹、球结膜水肿和搏动性耳鸣。右侧颈内动脉血管造影显示，在C5段存在高流量直接型颈内动脉海绵窦瘘（CCF），且有血液反流至大脑外侧浅静脉和深静脉、眼上静脉、岩上窦和岩下窦。血管内超声检查（IVUS）显示颈内动脉（ICA）C5段存在一个大型瘘口。在IVUS监测下，通过经动脉和经静脉途径进行了弹簧圈栓塞术。手术过程中，IVUS准确检测到一个弹簧圈突入颈内动脉主干，从而得以保留颈内动脉主干。IVUS监测对于使用弹簧圈栓塞直接型CCF很有用。
