Ding Chun-Long, Zhang Chun-Lei, Hua Feng, Xi Shao-Dong, Zhou Qin-Wei, Wang Hui-Jun, Chen Jun-Jie, Qiu Jie
Department of Neurosurgery, Xishan People's Hospital, Wuxi, Jiangsu 214000, P.R. China.
Department of Neurosurgery, 904th Hospital of Chinese People's Liberation Army Joint Logistic Support, Wuxi, Jiangsu 214000, P.R. China.
Med Int (Lond). 2021 Sep 17;1(5):16. doi: 10.3892/mi.2021.16. eCollection 2021 Nov-Dec.
Traumatic carotid-cavernous fistula (TCCF) with perimedullary venous drainage and delayed myelopathy is a relatively rare clinical lesion. Endovascular embolization using embolic agents is the preferred treatment for patients with a poor collateral circulation. The present study describes the case of a 45-year-old male with TCCF, who presented with progressive cervical myelopathy for 1 month. A previous history of the patient included an anterior skull base fracture induced by a traffic accident 2 years prior. Cervical spinal magnetic resonance imaging (MRI) revealed dilated perimedullary veins and cervical spinal cord edema. Cerebral digital subtraction angiography revealed a direct CCF with perimedullary venous drainage. The patient received endovascular treatment with coils and an Onyx liquid embolic system to occlude the fistula, and his symptoms were relieved when he was discharged 3 weeks later. The patient then felt normal and a cervical spinal MRI revealed the disappearance of the perimedullary veins dilation and spinal cord edema at the 6-month follow-up. To the best of our knowledge, only three cases of CCFs with perimedullary venous drainage presenting with myelopathy have been previously reported. The present study also discussed the possible pathological mechanisms for this rare presentation. Moreover, it is suggested that the possibility of CCFs as a cause of cervical myelopathy needs to be taken into consideration.
伴有髓周静脉引流和迟发性脊髓病的创伤性颈内动脉海绵窦瘘（TCCF）是一种相对罕见的临床病变。对于侧支循环较差的患者，使用栓塞剂进行血管内栓塞是首选治疗方法。本研究描述了一例45岁男性TCCF患者的病例，该患者出现进行性颈髓病1个月。患者既往史包括2年前因交通事故导致的前颅底骨折。颈椎磁共振成像（MRI）显示髓周静脉扩张和颈髓水肿。脑数字减影血管造影显示为伴有髓周静脉引流的直接颈内动脉海绵窦瘘。患者接受了用弹簧圈和Onyx液体栓塞系统进行的血管内治疗以闭塞瘘口，3周后出院时症状缓解。患者随后感觉正常，6个月随访时颈椎MRI显示髓周静脉扩张和脊髓水肿消失。据我们所知，此前仅报道过3例伴有髓周静脉引流并出现脊髓病的颈内动脉海绵窦瘘病例。本研究还讨论了这种罕见表现的可能病理机制。此外，提示需要考虑颈内动脉海绵窦瘘作为颈髓病病因的可能性。
