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The authors described two cases with primitive trigeminal artery. Case 1 was a 32-year-old woman who suffered dizziness and a serious pulsatile intracranial bruit on the left ear, and sometimes associated with pulsatile intracranial bearing-pain on the left temporal side six months before she was admitted to the hospital. She also suffered from obvious diplopia on left lateral gaze for the last 5 months. She had suffered no recent trauma. Magnetic resonance imaging(MRI) demonstrated a suspected intracranial aneurysm located in left cavernous sinus. Digital subtraction angiography (DSA) was performed and a primitive trigeminal artery-cavernous sinus fistula in left side was found. Intraluminal occlusion of the fistula was successfully performed immediately after angiography using 6 Guglielmi detachable coils (GDC), and the patient was cured finally. Case 2 was a 28-year-old woman who suffered a serious intermittent cephalodynia associated with soreness on the left body two years before she was admitted to the hospital. She had suffered no recent trauma. Magnetic resonance angiography(MRA) demonstrated a suspected intracavernous aneurysm of the right internal carotid artery, Digital subtraction angiography (DSA) was performed. Right internal carotid angiography showed a primitive trigeminal artery (PTA) run between the cavernous segment of the internal carotid artery and the distal portion of the basilar artery. On initiation of PTA of R-ICA a small wide-necked saccular aneurysm was incidentally visualized. The aneurysm was successfully embolized after angiography using 2 Stent (Neuroform, 4.5mmm × 20mmm)-assisted detachable coils (Matrix), the ICA and PTA were preserved, and the patient was cured finally.
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经眼上静脉治疗海绵窦动静脉瘘二例
海绵窦动静脉瘘,又称颈动脉海绵窦瘘(carorid cavernous sinus fistula)患者因眼部症状就诊眼科时偶而被漏诊或误诊.本文就我科近接诊的两例海绵窦动静脉瘘患者的诊治进行报告.
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第15例蛋白尿-高热-左眼球突出、失明(Ⅱ)
本例的病历摘要见本卷第5期第359页讨论和分析感染性海绵窦血栓形成(septic cavernous sinus thrombosis)是一种较为少见的临床急症.它多是因面部感染(50%)、鼻窦炎(30%)、牙部感染(10%)和中耳炎(7%)等侵犯至海绵窦区,继发引起海绵窦血栓形成,造成眼静脉回流受阻和海绵窦周围第Ⅲ、Ⅳ、Ⅵ对脑神经和第Ⅴ对脑神经第一支受累,从而出现一系列特征性临床表现的综合征.本病的感染菌以金黄色葡萄球菌、化脓性链球菌及厌氧菌多见[1,2].
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颈内动脉海绵窦瘘的影像学表现与检查方法评价
颈内动脉海绵窦瘘(carotid cavernous sinus fistulas,CCSF)系颅内常见的动静脉瘘,是发生在颈内动脉及其分支血管与海绵窦之间的直接或间接异常沟通,从而使动脉血经瘘道进入海绵窦,造成一系列循环紊乱和临床综合征.病因包括外伤性、自发性及先天性3种,以外伤所致多见.外伤性颈内动脉海绵窦瘘(traumatic carotid-cavernous fistula,TC-CF)可分为两型:Ⅰ型,海绵窦段颈内动脉本身撕裂,与海绵窦形成直接交通;Ⅱ型,海绵窦段颈内动脉的分支断裂形成与海绵窦的间接交通;常有对侧颈内动脉或同侧的颈外动脉分支,通过侧支吻合向断裂的动脉远端供血[1].
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高压氧综合治疗海绵窦综合征一例
海绵窦综合征是由各种蝶鞍旁损害累及海绵窦所致,肿瘤、颈动脉瘤、颈动脉-海绵窦瘘和炎症是海绵窦综合征的主要病因.2007年9月我中心收治1例由外院误诊并给予手术治疗的海绵窦综合征患者.现报告如下.
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颈动脉海绵窦瘘血管内治疗的若干经验
颈动脉海绵窦瘘(carotid cavernous sinus fistula,CCF)早由BARON在1835年报道,一般系指由外伤造成颈内动脉海绵窦段本身或其分支破裂,与海绵窦之间形成的异常动静脉交通,并由此引发一系列的临床症状和体征.其多数情况由颈内动脉本身破裂引起,极少数颈动脉海绵窦瘘主要或完全由颈外动脉供血,特称颈外动脉-海绵窦瘘.按病因可分为创伤性颈内动脉海绵窦瘘(TCCF)和自发性颈内动脉海绵窦瘘(SCCF),而75%为TCCF,占颅脑外伤患者的2.5%.目前,颈动脉海绵窦瘘诊断和介入治疗已不成问题,治愈率也高.现就颈动脉海绵窦瘘血管内治疗的若干问题介绍一些经验,以便与同道商榷.
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海绵窦海绵状血管瘤的影像学诊断
颅内海绵状血管瘤(cavernous hemangiomas,CHs)少见,约占所有脑血管畸形的5%~16%[1].颅内CHs多位于脑实质内,少数生长在脑外,位于脑外者绝大多数位于海绵窦内,海绵窦CHs约占颅内CHs的13%左右[2,3].海绵窦CHs国内外报道较少,术前诊断常易误诊,作者综合近年来文献就其临床、病理和影像表现综述如下,以期提高对海绵窦CHs的认识.
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海绵窦综合征影像诊断
海绵窦综合征又称FLTX综合征Ⅱ或Foix综合征,是由多种病变累及海绵窦的动眼神经、滑车神经、外展神经及三叉神经眼支引起以痛性眼肌麻痹为特征的一组临床综合征[1].本文回顾分析经临床及手术病理证实43例海绵窦综合征的CT、MRI及DSA表现.分析海绵窦综合征的病因、影像学表现及其价值.
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颅内动脉瘤和颈内动脉海绵窦瘘的微弹簧圈栓塞治疗
脑动脉瘤和颈内动脉海绵窦瘘(简称CCF)的治疗是神经外科的难点.近年来,神经介入放射学的发展为这些疾病的治疗开辟了新的道路,取得了明显的效果[1~4].我院自1994~1995年间采用国产微弹簧圈对2例脑动脉瘤和4例CCF进行了栓塞,效果较为满意,现总结如下.
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急诊介入救治外伤性海绵窦颈内动脉瘤破裂大出血
病人男性,30岁.因车祸昏迷入院.CT诊断为颅骨开放性骨折,颅底广泛骨折,蛛网膜下腔出血.入院后10 d,突然左鼻腔大出血,5 min内出血近1000 ml,用麻黄素棉球两鼻腔填塞压迫止血无效.左眼球外突,球结膜充血水肿并失血性休克.纠正休克后全麻下做全脑血管造影检查.显示左颈内动脉C4段一1 cm×1.5 cm的囊袋状突起,并有造影剂外渗,诊断C4段外伤性动脉瘤破裂出血.经造影观察各交通动脉均通畅后,用Magic-BD可脱性球囊微导管栓塞治疗.术前先加压病人左颈内动脉,使其血流阻断30 min以上,观察病人神志、瞳孔、四肢肌张力及活动度不受影响时,方行栓塞治疗.将Magic-BD微导管送至病变位置后,开始充盈球囊.先后共充盈3枚球囊,均因C4段动脉内有刺入的骨折碎片,致使球囊刺破,球囊栓塞不成功.为抢救生命,用直径分别为8 mm和5 mm钢圈两枚,闭塞左颈内动脉.栓塞后病人出血迅即停止,血压逐渐回升.1周后病人下床活动自如,半月后出院(图1,2).