فیستول کاروتید – کاورنوس ناشی از ترومای نافذ بینی در یک کودک

مقدمه/ بیان مساله : A traumatic carotid-cavernous fistula occurs when a penetrating injury or blunt trauma rupture carotid arteries or their branches inside the cavernous sinus. Subsequently, the arterial blood flow with high pressure is shunted into the cavernous sinus, leading to a retrograde blood flow in its emerging veins.معرفی بیمار : In this article, we describe an unusual case of traumatic type A carotid-cavernous fistula (CCF) in a ۲.۵-year-old boy following a penetrating skull base injury by a screwdriver which had been accidentally inserted deeply into his nose. From day ۲, the left eye became hyperemic and a gradual proptosis appeared which, over the following days was accompanied by limited ocular movements. On the brain CT scan, no orbital pathology could be found and with the suspicion of orbital cellulitis, the patient received systemic intravenous antibiotics for ۳ weeks. Nevertheless, the patient's symptoms didn’t improve. Meanwhile, the patient developed acute nausea and vomiting and became lethargic; and his repeated brain CT scan revealed an acute hydrocephalus and intraventricular hemorrhage. Urgently, the patient underwent an external ventricular drain (EVD) placement surgery with success. On the same day fine cut orbital CT scan, the typical engorgement of the superior ophthalmic vein was detected and with the diagnosis of traumatic carotid cavernous fistula (CCF), the patient underwent the digital subtraction angiography (DSA) in which a severe laceration of the internal carotid artery siphon was detected. Endovascular embolization of venous part of fistula by coiling and reconstruction of ICA wall by stenting was done.

کلیدواژه ها:

Trauma ، carotid cavernous fistula ، carotid artery