External carotid artery-cavernous fistula surgery

The external carotid artery - cavernous sinus is rare. Edward only saw 36 cases in the 1977 collection. Hayes (1963) believes that the main blood supply artery of the external carotid cavernous fistula (in the anterior cavernous sinus is mostly from the branch of the infraorbital artery, the posterior part is mostly from the pharyngeal ascending artery, and can also be supplied through the anastomosis with the ophthalmic artery. Trauma is caused by less, most of which is caused by spontaneous rupture of the meningeal branch of the external carotid artery. Or because of the rupture of the branch of the internal carotid artery in the cavernous sinus, the collateral circulation of the meningeal branch of the external carotid artery is used to supply blood. The blood supply may also come from The meningeal branch of the vertebral artery. This disease develops slowly, and symptoms usually appear in adulthood. Before the selective cerebral angiography is applied, the diagnosis is almost always after the isolated symptoms are not alleviated or relapsed. An angiogram was first discovered. The external carotid cavernous sinus fistula has natural healing, self-healing after cerebral angiography and radiation cure. Therefore, some people advocate conservative treatment, but when the symptoms worsen, they should still be treated surgically. Selective angiography of the internal carotid artery, external carotid artery, and vertebral artery should be performed before surgery to determine the location of the pupil and the blood supply artery. Curing disease: Indication External carotid artery-cavernous fistula surgery is applicable to: 1. Patients with ocular symptoms such as pulsatile eyesight disorder. 2. Headache, dizziness, tinnitus, auscultation with murmurs, and symptoms gradually worsen. 3. The diagnosis was CCF, but the symptoms did not improve or relapse after isolation, and then confirmed by angiography as the external carotid artery system. Contraindications The symptoms are mild and there is no aggravation for a long time. Preoperative preparation 1. Skin preparation, wash the head with soap and water 1 day before the operation, and shave the hair on the morning of the operation. 2. Fasting the morning of surgery. It can be enema in the evening before surgery, but when the intracranial pressure is increased, the enema should be removed to avoid sudden deterioration of the condition. 3. Oral 0.1g can be given to phenobarbital before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. Surgical procedure Anesthesia and position Local anesthesia can be used for neck surgery and general anesthesia with tracheal intubation during craniotomy. According to the different surgery, take the corresponding position. Surgical procedure Four different surgical methods can be considered for different blood supply arteries in angiography. 1. Ligation of the external carotid artery in the neck. See the neck surgery in isolated surgery for surgical procedures. 2. Block the middle meningeal artery at the spine. See the method of cutting off the middle meningeal artery during the transthoracic trigeminal sensory root resection (Frazier surgery). 3. Transcranial blocking of the feeding artery of the dura mater in the anterior cranial base of the anterior cranial fossa. Craniotomy was performed through the frontal or pterional approach to expose the anterior cranial fossa and the cranial fossa, and the blood supply artery was blocked by bipolar coagulation. However, it is difficult to block the blood supply artery behind the cavernous sinus. 4. Block the sinus. It is the same as the treatment of internal carotid cavernous fistula. complication 1. Intracranial hematoma, often caused by insufficient hemostasis during surgery. 2. Cerebral vasospasm and cerebral insufficiency, different measures should be taken according to different situations.