Direct Carotid-Cavernous Sinus Fistula (CCF) Due To Spontaneously Ruptured Large Cavernous Sinus Aneurysm-Case Report

海綿竇內大型動脈瘤破裂導致頸動脈－海綿竇瘻管之病例報告

陳芳婷(Fang-Ting Chen) ； 王清泓(Tsing-Hong Wang) ； 周介仁(Jieh-Ren Jou)

《中華民國眼科醫學會雜誌》 48卷3期 (2009/12) Pp. 346-352

https://doi.org/10.30048/ACTASOS.200912.0018

摘要

目的：提出一病例由海綿竇內大動脈瘤破裂導致之頸動脈－海綿竇瘻管。
方法：病例報告。
結果：一位61歲高血壓女性病患因突發吐劇烈頭痛至急診就醫，數小時後右眼出現眼皮水腫、凸眼、及眼球運動麻痺之症狀，且眼科症狀在數小時之內快速惡化；病患之右眼眼壓高達59毫米汞柱。顯影劑注射後之電腦斷層照影及血管攝影顯示一大型海綿竇內動脈瘤併右側上眼靜脈充血，確定診斷為動脈瘤破裂所致頸動脈－海綿竇瘻管。病患接受動脈瘤栓塞後眼部症狀於數天內緩解，且無腦缺血之併發症發生。
結論：直接型頸動脈－海綿竇瘻管雖多見於頭部創傷後，但海綿竇內之動脈瘤破裂剪亦為一可能原因。

並列摘要

Purpose: To report a case of acute proptosis and direct carotid-cavernous fistula (CCF) caused by spontaneous rupture of a large cavernous carotid aneurysm
Method: Case report.
Result: This 61-year-old lady visited our emergent service with the chief complaint of sudden-onset severe headache and right periorbital pain. The systolic blood pressure was 210mmHg, and no trauma history was noted. Ophthalmic examinations revealed swelling of eyelids, proptosis, markedly injected and tortuous conjunctival vessels, extraordinarily high intraocular pressure (IOP), and ophthalmoplegia in the right eye, and these symptoms deteriorated rapidly within hours. Contrast computed topography (CT) angiography and catheter cerebral angiography showed a large cavernous sinus aneurysm with anterior drainage into superior ophthalmic vein and posterior drainage into inferior petrosal sinus in the right side. Under the impression of a ruptured cavernous carotid aneurysm inducing carotid-cavernous sinus fistula (CCF), transarterial embolization of the aneurysm was performed immediately. The IOP returned to normal range on the same day after the procedure, and the other ocular manifestations gradually recovered in the following days without any neurologic sequels.
Conclusion: Spontaneous rupture of intracavernous carotid aneurysm, although uncommon, is a possible cause of direct CCF, especially in middleaged or elderly women with systemic hypertension and without history of head trauma.

並列關鍵字

Carotid-cavernous fistula ； cavernous sinus aneurysm ； glaucoma