Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2020 May;137:338-340. doi: 10.1016/j.wneu.2020.01.228. Epub 2020 Feb 6.
Cavernous-carotid fistulas (CCFs) can present with a variety of symptoms depending on the anatomy of the fistula and its venous drainage. Patients most commonly present with scleral injection, pulsatile exophthalmos, and/or chemosis.
We report a patient who presented with intraparenchymal hemorrhage in the absence of any of the commonly associated ocular symptoms and signs. After multiple imaging studies, the CCF was diagnosed and treated with endovascular embolization that resulted in complete occlusion of the fistula and reflux of embolysate into one of its connecting veins.
The morphology of the venous drainage can lead to atypical hemorrhagic presentation, whereas dilatation of one of the tributary veins with cortical venous reflux should warn the interventionist the path the embolysate may follow. We provide our experience with this unique presentation and its treatment.
海绵窦颈动脉瘘（CCF）可根据瘘管的解剖结构和静脉引流方式呈现出多种症状。患者最常出现巩膜充血、搏动性眼球突出和/或球结膜水肿。
我们报告了一例患者，其出现脑实质内出血，而无任何常见的相关眼部症状和体征。经过多次影像学检查，诊断为 CCF，并采用血管内栓塞治疗，结果瘘管完全闭塞，栓塞剂反流至其中一条连接静脉。
静脉引流的形态可导致非典型出血表现，而其中一条属支静脉扩张伴皮质静脉反流应提醒介入治疗医生栓塞剂可能遵循的路径。我们提供了这种独特表现及其治疗的经验。
