Kamio Yoshinobu, Hiramatsu Hisaya, Kamiya Mika, Yamashita Shuhei, Namba Hiroki
Department of Neurosurgery, Department of Radiology, Hamamatsu, Japan.
Hamamatsu University School of Medicine, Hamamatsu, Japan.
J Korean Neurosurg Soc. 2017 Jan 1;60(1):89-93. doi: 10.3340/jkns.2015.1206.001. Epub 2016 Dec 29.
Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus.
直接颈动脉海绵窦瘘（CCF）导致的幕下脑出血非常罕见。据我们所知，仅有4例此类病例被报道。直接CCF导致的小脑出血尚未见报道。我们描述了一名63岁女性，她在接受上颌骨癌上颌骨切除术后3天出现意识减退。计算机断层扫描显示小脑出血。磁共振血管造影显示左侧直接CCF通过左侧岩上窦（SPS）引流至左侧岩静脉和小脑静脉。她之前的手术已切除翼静脉丛和面静脉。血流增加和引流减少可能导致包括岩静脉和小脑静脉在内的幕下静脉压力升高。海绵窦有多个引流途径，但SPS是幕下静脉引流的最重要途径之一。SPS后段狭窄或缺失也可导致小脑和脑桥静脉压力升高。我们强调，对于伴有皮质静脉反流的直接CCF，应进行精确评估，以确定血流动力学状态和海绵窦的静脉引流情况。
