Terashima Hanae, Higa Takashi, Kato Koichi, Tominaga Tadasuke, Nakagawa Masanori, Kadoyama Shigeru, Ujiie Hiroshi, Teramoto Akira
Department of Neurosurgery, Tokyo Rosai Hospital.
No Shinkei Geka. 2017 Jun;45(6):527-532. doi: 10.11477/mf.1436203544.
Bilateral traumatic carotid-cavernous fistula(CCF)is rare. It is most commonly caused by a direct head or face injury involving the cavernous sinus and develops immediately after trauma. We report a case of bilateral traumatic CCF that occurred as an intracerebral hematoma(ICH)mimicking apoplexy 5 months later. We treated the patient with point occlusion of venous reflux causing an ICH using coil embolization to remove the hematoma. Three days after we performed trans-venous occlusion of the intercavernous connection and right cavernous sinus using coil embolization through the right inferior petrosal vein, it was identified that the left CCF was occluded after first embolization into the left sylvian vein. The mechanism of delayed development of traumatic CCF and spontaneous disappearance of CCF after occlusion of venous reflux are discussed.
双侧创伤性颈动脉海绵窦瘘(CCF)较为罕见。它最常见的病因是涉及海绵窦的头部或面部直接损伤,且在创伤后立即发病。我们报告一例双侧创伤性CCF病例,该病例在5个月后以模仿中风的脑内血肿(ICH)形式出现。我们通过使用弹簧圈栓塞去除血肿,对导致ICH的静脉反流进行点状闭塞来治疗该患者。在通过右岩下静脉使用弹簧圈栓塞对海绵间连接和右侧海绵窦进行经静脉闭塞三天后,发现在首次栓塞入左侧大脑外侧静脉后左侧CCF被闭塞。本文讨论了创伤性CCF延迟发病的机制以及静脉反流闭塞后CCF的自发消失情况。