眶颅穿通伤致开放性颈内动脉海绵窦瘘一例并文献复习  

Posttraumatic carotid -cavernous fistula following orbitocranial penetrating injury： case report and literature review

作　　者：赵明亮[1] 薛德友[1] 涂悦[1] 王延民[1] 胡群亮[1] 张赛[1] 

机构地区：[1]武警医学院附属医院脑系科中心,天津300162

出　　处：《中华神经外科杂志》2011年第10期1049-1052,共4页Chinese Journal of Neurosurgery

摘　　要：目的结合病例并文献复习，探讨眶颅穿通伤后颈内动脉海绵窦瘘（CCF）的诊断及治疗策略。方法1例19岁男性被长约12cm的木质异物经左侧眼眶穿入对侧海绵窦区，在外院手术拔除异物失败。入院后最初的脑血管造影检查未发现CCF，但轻微触动异物后，可发现右侧隐匿存在的CCF。经充分术前准备后我们完整拔除异物，并在1min内对呈开放性的CCF进行了血管内栓塞治疗。结果经过介入治疗后，CCF完全消失；尽管术后发生了脑积水、颅内感染、脑脊液鼻漏等一系列并发症，但经过合理治疗，患者出院时伤口愈合良好，未遗留神经功能缺损和视力障碍。结论眶颅穿通伤常导致颅内血管损伤和颅内出血，强烈建议对这类患者常规进行脑血管造影术检查；一旦异物穿人海绵窦区，应高度怀疑CCF的发生，最好能在神经介入支持下取出异物；另外，需特别注意的是，对于有异物滞留的眶颅穿通伤，其并发的CCF可能不会表现出典型症状，易于漏诊，草率地拔除异物将导致隐匿的CCF呈开放性，导致大出血致患者迅速死亡。Objective To explore the diagnosis and treatment strategies of carotid - cavernous fistula （CCF） following orbito - cranial penetrating injury with cases report and literature review. Method We report a case of occult post - traumatic CCF in a 19 - year - old male who was stabbed by a 12 em long wooden foreign body from left orbit into the contralateral cavernous sinus region. Original cerebral angiography demonstrated no CCF. But after a tentative lightly move of foreign body, fight occult post - traumatic CCF was found. With adequate preoperative preparation, foreign body was extracted completely and CCF was managed with endovaseular embolization within no more than one minute. Results After embolization treatment, CCF was disappeared completely. Although several complications ensuing, such as hydrocephalus, intraeranial infeion and leakage of cerebrospinal fluid, the patient was discharged with the wounds well healed and no neurological deficits and visual loss on the 21st day after the operation. Conclusions As orbito - cranial penetrating injury frequently results cerebral vascular injury which may cause fatal intraeranial hemorrhage, early assessment of the patient with cerebral angiography is strongly recommended. Secondly, in case foreign body penetrated into cavernous sinus region, CCF should be highly suspected and retained foreign body had better to be pulled out in support of neurological intervention. Finally, one should keep in mind that post -traumatic CCF due to orbito -cranial penetrating injury can be latent or show no typical symptoms, and extraction rashly of residual foreign body may lead to fatal bleeding.

关 键 词：颈内动脉海绵窦瘘 眶颅穿通伤 血管内栓塞 

分 类 号：R651.1[医药卫生—外科学]