Shurkhay Vsevolod, King Brandon L, Auschwitz Tyler S, Charles Michael, Kalani M Yashar S
The Trauma and Neuroscience Institutes, St. John's Hospital and Medical Center, Tulsa, Oklahoma.
J Neurosurg Case Lessons. 2025 Jan 27;9(4). doi: 10.3171/CASE24618.
Direct carotid-cavernous fistulas (CCFs) are relatively rare but dangerous complications of penetrating traumatic brain injury or maxillofacial trauma. A variety of clinical signs have been described, including ophthalmological and neurological ones. In some cases, severely altered cerebral blood flow can present as massive life-threatening bleeding through the nose, subarachnoid hemorrhage, and/or intraparenchymal hemorrhage. Although intuitively it makes sense that the elevation of venous pressure can obstruct the absorption of cerebrospinal fluid after the formation of a CCF, reports of CCFs presenting with acute acquired hydrocephalus do not exist.
This case illustrates the development of hydrocephalus in a patient with a direct CCF.
In the absence of a direct path of access to the cavernous sinus due to occlusion of the carotid artery and difficult venous access, a transcirculation route was used to obliterate the CCF and resolve the hydrocephalus in this patient. https://thejns.org/doi/10.3171/CASE24618.
直接型颈内动脉海绵窦瘘（CCF）是穿透性颅脑损伤或颌面外伤相对罕见但危险的并发症。已描述了多种临床体征，包括眼科和神经科体征。在某些情况下，严重改变的脑血流可表现为经鼻大量危及生命的出血、蛛网膜下腔出血和/或脑实质内出血。虽然直观上CCF形成后静脉压升高会阻碍脑脊液吸收是有道理的，但尚无CCF伴急性后天性脑积水的报道。
本病例说明了一名直接型CCF患者脑积水的发展情况。
由于颈动脉闭塞且静脉通路困难，无法直接进入海绵窦，因此采用经循环途径闭塞该患者的CCF并解决脑积水问题。https://thejns.org/doi/10.3171/CASE24618 。
