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Microsurgery combined endovascular treatment of carotid cavernous fistula embolization in 1 case

Song Shizhong Song Lin Chenghai Qitie Wei Chu-ming Zhang Xiaodong plunger endovascular treatment of carotid cavernous fistula is (CCF) of the preferred method,[link widoczny dla zalogowanych], usually, most of the cases, arterial or venous Road can get satisfactory results. We first reported use of microsurgical craniotomy combined with vascular micro-spring Zhu Gui within the tungsten plug in the treatment l means patients with arterial and venous thrombosis were not treated patients with recurrent CcF good effect. 1 patient clinical data, male, 35 years old. 2 months ago outside the hospital diagnosed as left CCF months after the symptoms and signs of relapse. VIII hospital examination: mild right exophthalmos. the right conjunctival edema, Xin diagnosis is not known and intracranial vascular murmur. DsA create a video show all the left cerebral ICA completely deleted boat j Cyprus, the left c 【== F. fistula in C3, the junction of the bottom, the blood from the left posterior communicating artery (PG) and the anterior communicating artery (ACoA) upstream to the fistula, while the left external carotid artery branch of meningeal in blood. contrast agent between the left cavernous sinus cavernous sinus flow through to the right cavernous sinus drainage to the right eye, vein. Try using endovascular treatment alone failed to determine craniotomy Endovascular treatment of joint . under general anesthesia on the left-wing point of the footpath, micro-drilling and grinding mill and the former than the medial sphenoid ridge clinoid process,[link widoczny dla zalogowanych], exposure to the left of IQ & cI, and the island section of the left IcA and PmA were placed at the temporary aneurysm clip blocking blood flow in the artery below the left eye at the puncture on the left about 2yAII1 ICA, set one set of 18G needle. and then a 18 Xi leaders Tracker catheter to the left cavernous sinus fistula. x-ray monitoring, has given away six tungsten micro-coil, with a total length of 210 iv embolization procedure. repeated injection of contrast agent to monitor the situation fistula plug at boat j. When anyone to six coils emblem seen after contrast agent and the G segment in the left ICAC2 retention, no draining veins. removal of micro-guide business and needle sets, micro incision consistent with the left ICA. Postoperative cerebral angiography showed the left side is almost complete occlusion of the fistula CCF, micro-coils filling the left cavernous sinus was no draining veins,[link widoczny dla zalogowanych], the left distal ICA and the fistula to maintain patency of the ophthalmic artery blood flow. patients with symptoms and signs gradually disappeared, were discharged after 15d. followed up for 6 months without recurrence. 2 discussions Gui plug endovascular surgery has been recognized as the treatment CCF's preferred method of arterial approach using detachable balloon embolization line (vein or rock, sinus and other vein treatment. In recent years, micro-coils with platinum or Guglielmi detachable coil treatment of CCF, make up a GUI plug detachable balloon technique deficiencies. in this case CCF patients, fistula on the left side, and eye symptoms manifested in the fistula at the opposite side, may be injured in the left eye was also involved and the boat j vein plug, or the left ophthalmic vein and cavernous sinus is not a priori traffic, while the sponge between the Doufa Yu good blood flows through the drainage to the contralateral cavernous sinus between. endovascular treatment of the initial difficulties that may cavernous sinus fistula is too large or a fracture within the film, but was forced to balloon occlusion of the fistula with proximal ICA. recurrence of symptoms after angiography showed fistula to the left, whereas the left ICA occlusion,[link widoczny dla zalogowanych], the left vein and keep up with rock on both sides, can be considered under the sinus does not develop ways to take the next 3 fistula occlusion: ① the right IcA-AC. A a left brain delete lcA artery and left a fistula; ② left vertebral artery of a left posterior cerebral artery (PCA) of a left PCoA ~ left lcA bucket fistula; ③ the right side of a right cavernous sinus and ophthalmic vein between a sponge fistula, a left cavernous rustic. the purposes of one kind of way, the micro-catheter through tortuous blood vessels can not; and who left home when the tenant microcatheter PCA and P (kx & after the performance of patients with cerebral ischemia appears. forced to give up plug camp. repeated puncture and cut the right ophthalmic vein, due to expansion of the right ophthalmic vein is not obvious without success. So far. a separate element with endovascular embolization treatment of patients taking the cavernous sinus craniotomy operation the possibility of cranial nerve injury too, but below the ophthalmic artery occlusion in the left internal carotid artery, complicated to operate,[link widoczny dla zalogowanych], and can not guarantee the full Wei artery, and cranial surgery can not solve the blood supply of the middle meningeal artery in question. thus decided United craniotomy with microsurgery and endovascular treatment of this case were abandoned, and finally get good results. (t999-02-02 ,1999-03 a l5 Received Revised) Author: Hall Affiliated Hospital, Medical Tour Neurosurgery (Harbin, 15000IJ now Affiliated Hospital of Zhongshan Medical University Neurosurgery (Guangzhou, 510089)
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