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KMID : 0378019600030020123
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New Medical Journal
1960 Volume.3 No. 2 p.123 ~ p.125
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A-V Fistula of the Cavernous Sinus
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Abstract
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The Patient, 15 years old student was brought into the Emergency Ward of Severance Hospital on April 3, 1959 after being knocked unconscious by a running bus. On examination he was in coma and had a large subgaleal hematoma in the frontal region. Other-wise no abnormality was found. The skull X-ray films showed a depressed area of skull, measuring
e about 2 x 3 cm, in the left frontal region. About four hours after the injury the craniotomy was perforcoed under the local and endotracheal anesthesias. The depressed portion of the. bone was elevated. The linear fracture extending from the depressed area down to the left anterior fossa was found. A piece of bone was piercing into the frontal lobe and it was removed. There was no significant amount of the blood clots. Post-operatively the patient did well and regained
e the consciousness about twelve hours after the operation. The neurological examination on the 3rd hospital day showed the marked
e impairment of the vision of the left eye. He was able to identify
the movement at the distance of 30cra. About three weeks after the injury he started to complain of the discomfort in the left orbit and then the edema of the eyelids and gradually progressive protrusion of the left eyeball. He also started to hear and suffered from the "bruit" in the left eye and frontal region. On examination he showed the pulsating exophthalmos of the left eye, marked injection of the sclera and conjunctiva, engorgement of the retinal veins,hvpalgesia in the left forehead and bruit over the left eye and frontal region and impairment of the vision of the left eye. The digital compression of the common carotid artery was well tolerated and caused the temporary disappearence ´ of the bruit. About four weeks after the injury, one week after the appearance of the exophthalmus the left common carotid artery was ligated with a silver band. The bruit disappeared instantly but the remainders of the symptoms had persisted. He had no additional symptoms due to the ligation.
On June 9th, 1959, under the local and endotracheal anesthesias the left fronto-temporal craniotomy was performed. The internal carotid artery was ligated intracran-
ially with a silver clip below, the post-communicating artvrr. After the closure of the craniotojkgy wound the internal carotid after was ex-posed in the neck and was divided at about 2 cm above thte bifurcation. A large piece of muscle was introduced and pushes upward into the cavernous sinus, The operation was carried out by the Brooke and Dandy´s metyliod. The post-operative course wa,k uneventful and the patient meowed the marked improvement of sthe exophthalmus, disappearance of the conjunctival, scleral injo%z,tion and periorbital edema. He allowed no motor or sensory distut413aace. But the visual disturbance hate;persisted.
By the presentation th its case and review of the articles rrt like to emphasize the good res of the intraextracranial trapj~mg and muscle =packing` operati%n originated by Brooke and IDandy. It was reported that the; incidence of post-operative complicMtion after the ligation of the inter** carotid was very low due to th-4t development of the good collatteral circulation of the cerebrum i4n cases of the cavernous sinus A.1V fistula, In our case. we had no complications and the excellent i result was obtained.
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KEYWORD
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