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NR 1-3/2005
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Przetoki
tętniczo-żylne w zatoce jamistej. Porównanie przebiegu
jatrogennej bezpośredniej przetoki z przetoką pośrednią „low
flow”
Arterio-venous fistula of
cavernous sinus. A comparison of iatrogenic direct fistula with
low flow dura shunt syndrome
Heinrich Holak1, Nikolai Holak1,
Bertram Schier3, Sophie Holak2, Janusz
Huzarski4
1Z Kliniki Okulistycznej w Centrum Medycznym im R.
Virchowa w Salzgitter
Kierownik: dr n. med. Heinrich Holak
2Z Kliniki Okulistycznej w Schlossparklinik w
Berlinie
Kierownik: prof. dr n. med. Heinrich Bleckmann
3Z Zakładu Neuroradiologii w Centrum Radiologicznym w
Salzgitter
Kierownik: dr n. med. Rolf Teusch
4Z Narodowego Funduszu Zdrowia w Katowicach |
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| Summary: |
Purpose: Comparison
of symptoms of the low-flow dura shunt syndrome as a
small arterial anomaly in the cavernous sinus with the
direct, traumatic originated internal carotid artery
fistula.
Material and methods: The clinical case report
for two patients. The first case with a direct cavernous
sinus fistula was diagnosed using angiography and the
patient was treated with a detachable balloon catheter
through the inferior petrousal sinus. The second case
after the diagnosis was followed up with doppler
sonography.
Results: The first case developed the direct
cavernous sinus fistula after second thrombarteriotomy
of the right internal carotid stenosis. The diagnosis,
by typical clinical symptoms, was confirmed through the
cavernous sinus angiogram with enlarged superior and
inferior ophthalmic veins. The drainage was accomplished
through the inferior petrousal sinus and the
intercavernous sinus with accompanying signs of cortical
drainage. All clinical symptoms, except for the abducens
nerve palsy and the incomplete oculomotor nerve palsy,
were reduced after neurosurgical occlusion of the
fistula. The second case with the low-flow dura shunt
syndrome was symptomatic by hypertension crisis and some
spontaneous reduction was noticed.
Conclusions: The iatrogenic direct cavernous
sinus fistula is seldom but a very dangerous vital
complication of the internal carotid arterial stenosis
surgery and must be immediately closed through the
endovascular embolisation therapy. The low-flow dura
shunt syndrome may be in 50 % occluded spontaneously. |
| Słowa kluczowe: |
dura shunt syndrom,
jatrogenna przetoka tętniczo-żylna, przetoka pośrednia „low
flow”. |
| Key words: |
dura shunt syndrome,
iatrogenic arterio-venous fistula, „low flow” fistula. |
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