Li Sihao, Wang Ting, Lin Sen, Liu Lunxin, Zhang Changwei
Neurosurgery Department, West China Hospital of Sichuan University, Sichuan, China.
Ann Med Surg (Lond). 2022 Jul 12;80:104130. doi: 10.1016/j.amsu.2022.104130. eCollection 2022 Aug.
With the increasingly common operation of mechanical thrombectomy (MT) in acute cerebral infarction cases, iatrogenic CCFs were occasionally reported. All of cases reported type A CCFs, and patients were presented with either asymptom from generation of fistula to duration of postoperative follow-up or distinct presentations at once after MT.
A 48-year-old postmenopausal female, without history of systemic hypertension and diabetes mellitus, underwent an operation of MT outside our institution about half a year ago. An intraoperative DSA showed an iatrogenic low-flow fistula between meningohypophyseal trunk and ICA. After 4 mouths' postoperative conservative observation, patient's presentation progressed from asymptom to serious optic signs. The patient underwent -arterial interventional occlusion. On postoperative day one, visual presentations of patient relieved significantly.
We discuss the reason for possibility of iatrogenic injury to meningohypophyseal trunk and clinical progressive presentation. A sudden swerve just beyond derivation of meningohypophyseal trunk is prone to being damaged by a misguided guide wire. The progression of clinical presentation, as a focal point in our case, is not reported in iatrogenic before, but some studys still find that spontaneous dural CCFs are inclined to occur in middle-aged or elderly women, especially in postmenopausal women, so age and sex are regarded as background factors of progressing. In addition, the change of drainage route is an immediate cause of progressive presentations.
We expect that when a manipulation of MT is conducted leading an iatrogenic CCF, our neurointerventionist should maintain appropriate vigilance on sex, age, menstrual history and medical history, then take an earlier and timely interventional measure.
随着急性脑梗死病例中机械取栓术（MT）的操作日益普遍，医源性颈内动脉海绵窦瘘（CCF）偶有报道。所有报道的病例均为A型CCF，患者从瘘口形成到术后随访期间要么无症状，要么在MT后立即出现明显症状。
一名48岁绝经后女性，无系统性高血压和糖尿病病史，半年前在我院外接受了MT手术。术中数字减影血管造影（DSA）显示脑膜垂体干与颈内动脉之间存在医源性低流量瘘。术后经过4个月的保守观察，患者的症状从无症状进展为严重的眼部症状。患者接受了动脉介入栓塞。术后第一天，患者的视力症状明显缓解。
我们讨论了医源性损伤脑膜垂体干的可能性及临床症状进展的原因。在脑膜垂体干分支稍远处突然转弯的部位容易被误入的导丝损伤。作为我们病例中的一个焦点，临床症状的进展在之前的医源性病例中未见报道，但一些研究仍发现自发性硬脑膜CCF倾向于发生在中年或老年女性，尤其是绝经后女性，因此年龄和性别被视为症状进展的背景因素。此外，引流途径的改变是症状进展的直接原因。
我们期望在进行MT操作导致医源性CCF时，神经介入医生应在性别、年龄、月经史和病史方面保持适当警惕，然后尽早及时采取介入措施。
