創傷性內頸動脈假性動脈瘤併內頸動脈－海綿竇間瘻管導致遲發性鼻出血

Delayed Epistaxis Due to Traumatic Pseudoaneurysm of Internal Carotid Artery Associated with Carotid-cavernous Fistula

黃同村(Tung-Tsun Huang) ； 劉嘉銘(Chia-Ming Liu) ； 吳弘斌(Hung-Pin Wu) ； 陳培榕(Peir-Rong Chen)

《台灣耳鼻喉頭頸外科雜誌》 38卷1期 (2003/02) Pp. 32-37

https://doi.org/10.6286/2003.38.1.32

摘要

鼻出血導因於創傷性內頸動脈假性動脈瘤或內頸動脈－海綿竇間瘻管臨床上並不常見，一旦發生卻可能導致大量出血致命。由於鼻腔與內頸動脈有一段間隔，早期容易被忽略而延遲正確診斷。於2001年我們經歷一名顱顏部創傷併發右眼失明、眼肌麻痺及顱底骨折的患者，在創傷20天復反覆發生鼻出血。患者接受頭部電腦斷層及血管攝影檢查，證實為右側內頸動脈假性動脈瘤併內頸動脈－海綿竇間瘻管，經可分離式囊球血管內栓塞失敗，於是接受Hamby氏手術，包括顱內病變遠端處之內頸動脈阻斷、瘻管肌肉栓塞及頸部內外頸動脈血管結紮。術後病人復原情形良好，無神經學併發症及鼻出血再發現象。臨床上若遇見顱顏部創傷患者發生鼻出血，尤其是有失明、顱底骨折、眼窩骨骨折、或相關顱神經障礙時（第三、第四、第五之一及二分支、及第六對顱神經），要想到內頸動脈假性動脈瘤的可能；若患者有脈動性眼球突出、顱顏部血管雜音、結膜水腫或充血、或視覺障礙時，則需懷疑內頸動脈－海綿竇間瘻管。必要時安排血管攝影以確立診斷。

關鍵字

鼻出血 ； 假性動脈瘤 ； 內頸動脈－海綿竇間瘻管 ； 內頸動脈傷害

並列摘要

Traumatic pseudoaneurysm of the internal carotid artery and carotid-cavernous fistula are uncommon but potentially fatal causes of epistaxis. Because epistaxis may not develop until days to months after the craniofacial injury, it may cause difficulty in early recognition and delay treatment. In 2001, we experienced a patient suffering from craniofacial injury and complicating with right blindness, ophthalmoplegia, and skull base fracture. Recurrent epistaxis developed 20 days later. Computed tomography and angiography demonstrated right pseudoaneurysm of ICA associated with carotid-cavernous fistula. Detachable balloon occlusion was tried first but failed, so neurosurgery with Hamby technique was performed, including clipping of intracranial ICA distal to the pseudoaneurysm, muscle embolization of the fistula and ligation of cervical internal and external carotid artery. The patient recovered well without neurological complications and no further epistaxis was noted. Any patients presenting with epistaxis and a prior history of craniofacial injury should be considered for possible pseudoaneurysm of internal carotid artery, especially those with blindness, skull base fracture, orbital fracture, or related cranial nerve deficit (CN Ⅲ, Ⅳ, Ⅴ1-2, Ⅵ). Carotid-cavernous fistula should be considered when patients have pulsatile exophthalmos, bruit, chemosis, or visual disturbance. Angiography should be arranged to confirm the diagnosis.

並列關鍵字

epistaxis ； pseudoaneurysm ； carotid-cavernous fistula ； internal carotid artery injury