CTA-guided outflow-targeted embolization of direct carotid-cavernous fistula

被引：2

作者：

Liao, Chih-Hsiang ^{[1
,2
]}

Chen, Wen-Hsien ^{[4
]}

Liao, Nien-Chen ^{[3
]}

Tsuei, Yuang-Seng ^{[1
,2
,5
]}

机构：

[1] Chung Shan Med Univ, Inst Med, Taichung, Taiwan

[2] Taichung Vet Gen Hosp, Dept Neurosurg, Neurol Inst, Taichung, Taiwan

[3] Taichung Vet Gen Hosp, Dept Neurol, Neurol Inst, Taichung, Taiwan

[4] Taichung Vet Gen Hosp, Dept Neuroradiol, Taichung, Taiwan

[5] Triserv Gen Hosp, Natl Def Med Ctr, Dept Neurosurg, Taipei, Taiwan

来源：

NEUROSURGICAL FOCUS | 2019年 / 46卷

关键词：

direct carotid-cavernous fistula; outflow-targeted embolization; video;

D O I：

10.3171/2019.1.FocusVid.18447

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

This video presents a case of new-onset visual blurring, diplopia, and conjunctival injection after head injury. CTA of the brain revealed a direct carotid-cavernous fistula (dCCF) of the right side. Careful evaluation of CTA source images revealed that the fistula point was at the ventromedial aspect of the right cavernous internal carotid artery (ICA), about 3.6 × 3.6 mm 2 in size, with 3 main outflow channels (2 intracranial and 1 extracranial) (CTA-guided concept). DSA of the brain also confirmed the diagnosis but was unable to locate the fistula point in a large-sized dCCF. Through a transfemoral artery approach, 3 microcatheters were navigated to each peripheral channel to initiate outflow-targeted embolization. Intracranial refluxes were blocked first to avoid cerebral hemorrhages, followed by the extracranial outflow. During embolization, accidental dislodge of one coil into the sphenoparietal vein occurred, but no attempt of coil retrieval was made. Complete obliteration of the dCCF was achieved, and the patient recovered well without new neurological deficits. 4D MRA at the 3-month follow-up showed no residual dCCF. © AANS 2019, Except Where Prohibited By Us Copyright Law.

引用

页数：1