Artikel
Traumatic fistula between the spheno-parietal sinus and the middle meningeal artery – Case report
Traumatische Fistel zwischen Sinus sphenoparietalis und A.meningea media – Ein Fallbericht
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Veröffentlicht: | 11. April 2007 |
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Objective: We describe the case of a posttraumatic fistula between the middle menigeal artery and the spheno-parietal sinus and provide a review of the world literature.
Methods: A 53-year-old man was admitted with multiple brain contusions and a temporoparietal fracture after a head trauma with a GCS 3. On day 3 after the trauma he developed clinical signs of a sinus cavernosus syndrome with pulsating exophthalmos and chemosis on the left eye. Schiotz tonometry of the left eye showed a raised intraorbital pressure of 25-30 mmHg (normal value: 15 mmHg). The intraorbital pressure of the right eye was 20mmHg. Digital subtraction angiography showed a fistula between the middle meningeal artery and the spheno-parietal sinus. The fistula was closed by endovascular embolisation with Cook DCS-Coils (Cook R Ireland LTD, Limerick, Ireland).
Results: Clinical symptoms resolved completely immediately after the intervention. At follow-up (12 months) visual fields were intact. Visual acuity was not impaired. Overall GOS was 3.
Conclusions: Traumatic arterio-venous fistulas between the middle menigeal artery and the sinus spheno-parietalis are rare. Patients developing signs of increased intraorbital pressure in a delayed fashion after head injury should undergo angiographic evaluation. Endovascular therapy can provide definitive cure within the same procedure.