傳統腦血管造影發現創傷性頸動脈海綿竇瘻管罕見案例報告

Traumatic Carotid Cavernous Fistula Discovered Incidentally on Conventional Cerebral Angiography: Case Report

頸動脈海綿竇瘺管是頸動脈系統和靜脈海綿竇之間具有臨床特徵的的異常通管，其發病機制可能為創傷性或自發性。創傷性頸動脈海綿竇瘺管好發於道路交通事故患者。本案例為32歲女性，因道路交通事故導致頭部受傷。急診電腦斷層顯示蛛網膜下腔出血和左內頸動脈疑似動脈瘤。隨後非侵入性血管攝影皆顯示無動脈瘤或頸動脈海綿竇瘺管的發現，且無相關臨床特徵。然而雖無臨床徵象出現，一星期後的傳統腦血管造影卻顯示出頸動脈海綿竇瘺管的花瓣狀跡象。此個案表明即使無臨床特徵和非侵入性檢查的陰性影像仍無法有效排除創傷性頸動脈海綿竇瘺管診斷的可能性。

Carotid cavernous fistula (CCF) involves an abnormal communication between the cavernous sinus and the carotid arteries presenting with clinical features. Its pathogenesis may be traumatic or spontaneous. Traumatic CCF is a common occurrence in patients involved in road traffic accident. In our case, the patient was a 32-year-old woman who incurred a head injury in a road traffic accident. Emergency cranial CT scan revealed subarachnoid hemorrhage and suspected aneurysm of the left internal carotid artery. Subsequent non-invasive investigation of angiography was negative for aneurysm or CCF and no clinical feature of CCF was seen in this patient. However, a latter digital subtraction cerebral angiography showed florid signs of CCF. This case indicates that the absence of clinical features and negative non-invasive investigation does not exclude the possible diagnosis of traumatic CCF.