Chugh Arunit J S, Duan Yifei, Hu Yin C
Department of Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
Department of Neurological Surgery, University Hospitals, Cleveland, Ohio, USA.
BMJ Case Rep. 2021 Mar 22;14(3):e240596. doi: 10.1136/bcr-2020-240596.
Carotid-cavernous fistulas (CCFs) are abnormal connections between arteries and the cavernous sinuses. Traditionally, the Barrow Classification system has been used to characterise these fistulas based on their arterial supply from the internal carotid artery (ICA), external carotid artery (ECA) or both. We present a unique case of a patient with a complex CCF with arterial feeders from dural branches of the ECA, ICA and vertebral artery (VA), which, to our knowledge, has not been reported in the literature. Given unique arterial supply pattern involving contribution from the extracranial VA, this CCF falls outside of the traditional Barrow Classification system. The patient ultimately underwent a transfemoral transvenous coil embolisation using multiple dynamic venous routes with obliteration of bilateral CCFs and near complete resolution of her preoperative symptoms.
颈动脉海绵窦瘘（CCF）是动脉与海绵窦之间的异常连接。传统上，巴罗分类系统一直被用于根据其来自颈内动脉（ICA）、颈外动脉（ECA）或两者的动脉供血来对这些瘘进行分类。我们报告了一例独特的复杂CCF患者，其动脉供血来自ECA的硬脑膜分支、ICA和椎动脉（VA），据我们所知，文献中尚未有过此类报道。鉴于其独特的动脉供血模式涉及颅外VA的供血，此CCF不属于传统的巴罗分类系统。该患者最终通过多条动态静脉途径进行了经股静脉线圈栓塞术，双侧CCF闭塞，术前症状几乎完全缓解。
