Sato M, Yamaguchi K, Tadaki T, Sato I, Kodama N
Department of Neurosurgery, Ohta Nishinouchi Hospital, Fukushima, Japan.
No Shinkei Geka. 1995 Jun;23(6):515-9.
A case of a traumatic carotid-cavernous aneurysm after removal of cancer of the upper jaw was reported. A 63-year-old male complaining of massive epistaxis from the left nostril was admitted to our clinic. He had suffered from cancer of the left upper jaw and had been treated with radical operation. During the surgical procedure, massive bleeding which was considered to be from the left internal carotid artery, suddenly occurred. The hemorrhage was somehow controlled by packing with oxidized cellulose. He experienced recurrent massive epistaxis after admission. Cerebral angiograms revealed an anterior-medially projecting aneurysm arising from the cavernous portion of the left internal carotid artery. He had a good cross circulation from right to left on compression of the left carotid artery. This aneurysm at the carotid-cavernous portion was produced as a result of injury during an operation for cancer of the upper jaw. To prevent disastrous bleeding from the aneurysm, the aneurysm was then successfully treated by the trapping of extra-and intracranial carotid ligation in combination with left STA-MCA anastomosis. There was no recurrence of epistaxis after the operation. However, a low-grade fever persisted before operation and a blood culture showed MRSA sepsis after the operation. Intensive chemotherapy was performed for this MRSA sepsis, he died of the accompanying DIC. Although aneurysmal epistaxis following a severe closed head trauma is a well-known phenomenon, an iatrogenic carotid-cavernous aneurysm presenting with recurrent massive epistaxis is rare. Several comments were made about the iatrogenic carotid cavernous aneurysm, and the necessity of early diagnosis and treatment was emphasized.
报告了1例上颌骨癌切除术后创伤性颈内动脉海绵窦段动脉瘤病例。一名63岁男性因左侧鼻孔大量鼻出血就诊于我院。他曾患左侧上颌骨癌并接受了根治性手术。手术过程中，突然发生大量出血，考虑来自左颈内动脉。通过用氧化纤维素填塞，出血得到了一定程度的控制。入院后他反复出现大量鼻出血。脑血管造影显示一个从前内侧突出的动脉瘤，起源于左颈内动脉海绵窦段。压迫左颈动脉时，他有良好的右向左交叉循环。这个颈内动脉海绵窦段动脉瘤是上颌骨癌手术过程中受伤所致。为防止动脉瘤灾难性出血，随后通过颅外和颅内颈动脉结扎并结合左颞浅动脉-大脑中动脉吻合术成功治疗了该动脉瘤。术后鼻出血未再复发。然而，术前持续低热，术后血培养显示耐甲氧西林金黄色葡萄球菌败血症。针对该耐甲氧西林金黄色葡萄球菌败血症进行了强化化疗，他死于并发的弥散性血管内凝血。虽然严重闭合性颅脑损伤后动脉瘤性鼻出血是一种众所周知的现象，但以反复大量鼻出血为表现的医源性颈内动脉海绵窦段动脉瘤却很罕见。对医源性颈内动脉海绵窦段动脉瘤进行了几点讨论，并强调了早期诊断和治疗的必要性。
