gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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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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  • corresponding author C. Unterhofer - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
  • P. Waldenberger - Universitätsklinik für Radiologie I, Medizinische Universität Innsbruck, Innsbruck, Österreich
  • K. Twerdy - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
  • R. Bauer - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
  • M. Ortler - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 056

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc311.shtml

Published: April 11, 2007

© 2007 Unterhofer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.