carotid cavernous fistula
Introduction
Introduction of internal carotid cavernous fistula Internal carotid cavernous sinus fistula (CCF) refers to the internal carotid artery of the intracranial cavernous sinus segment or its branch rupture in the cavernous sinus segment, which forms an abnormal communication between the cavernous sinus and the cavernous sinus, resulting in the cavernous sinus. A series of clinical manifestations have occurred with increased stress. The structure of the only artery passing through the vein in the human body is the cavernous sinus, and because of the high incidence of craniocerebral trauma, the cavernous sinus area is prone to arteriovenous fistula, of which TCCF accounts for more than 70%. Since 1974, Serbinenko first reported the success of TCCF treatment with detachable balloon embolization. With the rapid development of medical imaging and the continuous improvement of embolic materials, and the continuous improvement of embolization technology for more than 30 years, endovascular treatment has become the first choice for the treatment of CCF. method. Because the clinical symptoms of CCF are progressively aggravated, effective measures must be taken to reduce the flow of arterial blood into the cavernous sinus. However, because the blood supply of sputum is multi-channel, the treatment of this disease is still an arduous task. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: pseudo aneurysm cerebral infarction headache
Cause
The cause of internal carotid cavernous fistula
The internal carotid artery of the intracranial cavernous sinus segment itself or its branch in the cavernous sinus segment ruptures, forming abnormal motor and vein communication with the cavernous sinus, resulting in increased pressure in the cavernous sinus.
Trauma (30%):
Caused by more than 75%, such as skull base fracture tear, bone puncture, foreign body penetrating injury, firearm injury; other factors can occur spontaneous CCF, such as aneurysm rupture, arteritis, atherosclerosis, spontaneous during pregnancy Sexual CCF.
Different causes can lead to different treatment processes and effects, such as brain injury caused by skull fractures, which can easily cause balloon rupture, which can cause embolization failure or increase the difficulty of treatment. The solution is as follows: (1) Accurately determine the position of the fistula (2) Do not use excessive force when filling the balloon; (3) Do not overfill the balloon with contrast agent; (4) Treat with multiple balloons.
Spontaneous injury (20%):
Spontaneous CCF, often more than one mouth, called complex CCF, some of the external carotid artery will also participate, and some involve the bilateral internal carotid artery, which will bring difficulty to the treatment, the solution is as follows: 1) angiography should be comprehensive to prevent omission; (2) first select the side of the neck-strain test to reduce the obvious side of the treatment, the effect is satisfactory and maintain the side of the internal carotid artery patency before the contralateral treatment; (3) first fill The cavernous sinus space that is far away from the mouth is assisted by a micro-coil if necessary, so as to avoid missing the fistula; (4) using a multi-balloon embolization.
Prevention
Internal carotid cavernous fistula prevention
There is no effective preventive measure for this disease. Early detection and early treatment are the key to prevention. Stay optimistic and happy. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood.
Complication
Internal carotid cavernous fistula complications Complications, pseudoaneurysm, cerebral infarction, headache
(1) Hematoma at the puncture site is due to insufficient local compression force or heparinization is not completely relieved, so it should be carefully examined after surgery to avoid such things.
(2) Cranial nerve spasm.
(3) Pseudoaneurysm, regular angiographic review after CCF treatment is necessary.
(4) The balloon is early cerebral infarction.
(5) Brain hyperperfusion: The patient presented with severe headache, and the symptoms were relieved 3 to 5 days after the dehydration treatment.
Symptom
Internal carotid cavernous sinus symptoms common symptoms eyeballs can not be free to move eye syndrome tremor vision disorder nosebleeds
Typical clinical manifestations are as follows:
(1) pulsatile exophthalmos (more than 95% of the literature), because the pressure in the cavernous sinus increases, affecting the reflux of the ocular vein.
(2) Tremor and murmur, which seriously affects the work and rest of the patient, which is the main reason for the patient's visit, so the disappearance of the noise is the standard during the treatment.
(3) Conjunctival edema and congestion, caused by restricted reflux of the ocular vein, is one of the reasons for the patient's visit.
(4) Eye movement limitation (rare) is caused by compression of the cranial nerve through the cavernous sinus.
(5) Vision loss.
(6) Neurological dysfunction and subarachnoid hemorrhage occur in the early stage of trauma, and are related to the location and extent of trauma.
(7) Fatal nosebleeds may be associated with pseudoaneurysms.
Examine
Examination of internal carotid cavernous fistula
An angiographic examination can be performed. Angiography is an auxiliary angiography. In the developed period of modern technology, angiography is widely used in the diagnosis and treatment of various diseases, which helps doctors to detect the disease and control the progress of the disease. The situation improves the survival rate of patients. Angiography is an interventional test in which a developer is injected into a blood vessel. Because X-rays cannot penetrate the developer, angiography can accurately reflect the location and extent of vascular lesions.
Diagnosis
Diagnosis and diagnosis of internal carotid cavernous fistula
Diagnostic criteria
The diagnosis of CCF is mainly based on its typical clinical manifestations and typical eye signs, especially with the history of craniocerebral trauma to determine the diagnosis. Head CT, MRI can be found in the eye, the development of cavernous sinus or thickening of the ocular vein can be used as an auxiliary diagnosis.
Diagnostic cerebral angiography provides comprehensive information for endovascular treatment.
However, it should be distinguished from the exophthalmos caused by other causes:
(1) Exophthalmetic goiter.
(2) Intraorbital tumors.
(3) vascular tumors in the iliac crest.
(4) Cavernous sinus thrombosis.
(5) Meningeal bulging. Experienced doctors often make the right judgments.
Differential diagnosis
Clinically, it needs to be differentiated from intraorbital meningioma bulging, intraorbital aneurysm and cavernous sinus thrombosis. In addition, pulsatile exophthalmos and intracranial vascular murmurs caused by other vascular malformations in the brain should be excluded, such as dural arteriovenous fistula and cerebral arteriovenous fistula.
