Muram Sandeep, Khader Eliyas Javed, Eesa Muneer, Mitha Alim P
Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
Department of Diagnostic Imaging, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
BMJ Case Rep. 2017 Aug 28;2017:bcr-2017-013248. doi: 10.1136/bcr-2017-013248.
Endovascular embolization is the standard approach for management of carotid cavernous fistulas (CCFs) due to the ease of access and reduced level of risk associated with the procedure compared with open surgery. We present here a case of a CCF that eventually led to the development of brainstem venous congestion from perimedullary venous drainage. This fistula was not amenable to endovascular embolization due to lack of either ophthalmic vein or petrosal sinus drainage. Therefore, a craniotomy with direct puncture of the cavernous sinus was performed, followed by coil embolization to completely treat this fistula. This case demonstrates an uncommon progression of venous drainage to Cognard grade V, rare development of symptomatic brainstem venous congestion and a unique method to combine an open surgical approach with endovascular embolization to treat CCFs.
血管内栓塞术是治疗颈动脉海绵窦瘘（CCF）的标准方法，因为与开放手术相比，该方法易于实施且手术风险较低。我们在此报告一例CCF病例，该病例最终导致髓周静脉引流引起脑干静脉充血。由于缺乏眼静脉或岩窦引流，该瘘无法进行血管内栓塞。因此，进行了开颅手术并直接穿刺海绵窦，随后进行弹簧圈栓塞以彻底治疗该瘘。该病例展示了静脉引流至Cognard V级的罕见进展、有症状的脑干静脉充血的罕见发生，以及一种将开放手术方法与血管内栓塞相结合治疗CCF的独特方法。
