内頸動脈海綿洞瘻に対する新手術法—凧揚げ法

A NEW SURGICAL TREATMENT OF CAVER-CAROTIDNOUS FISTULA:KITE METHOD

いとぐち

　内頸動脈海綿洞瘻は海綿洞内において内頸動脈と海綿洞との間に異常交通路が形成され，内頸動脈血が海綿洞内へ流入する疾病であり，本症には外傷性例と非外傷性例とがある。本症の発生によつて海綿洞内圧が上昇するために患側眼球静脈血の還流が障害され患側眼球の突出（時に両側眼球突出），眼球結膜の浮腫，充血，溢血および視力障害を発生するのみではなく，患者は著るしい頭蓋内雑音に悩まされ自殺を決心することさえある。

　本症に対する外科的治療は，はやくから諸家によつて種々考案されてきたが，いずれも患側内頸動脈血流を犠牲にせねばならなく，このため欠損手術といわねばならないのみならず，手術効果も不確実であつた。

As stated by Brooks, "any successful operative method for the cure of arteriovenous fistula must have as its primary object the closure of the fistul-ous opening and not the limitation of the blood flow through the segment of artery containing the fistula".

The ideal treatment of carotid-cavernous fistula would be one that closes the fistula without inter-fering with the lumen of the internal carotid artery but most of the surgical treatment have dealt with a reduction of the bloot fiow into the fistula by ligation of internal carotid artery extracranianially and intracranially.

This report describes the new surgical treatment of carotid-cavernous fistula by artificial embolization of the fistula alone with muscle guided by silk string with post-operative preservation of the inter-nal carotid artery blood flow.

The authors developed the operative technique consisting of the cervical intraluminal placement of a clipped muscle embolus attached to a Ethicon 4-0 silk string. The muscle embolus is allowed to ascend under controle with plain skull film, angiu-gram and ophthalmophonogram to the intracavero-ous portion of the carotid artery by loosening of silk string in the internal carotid artery with a few length step by step. The muscle embolus is intro-duced into fistula by pressure gradient between internal carotid artery and cavernous sinus. On the other hand, the silk string act as a protector for deviation of muscle embolus into cavernous sinus father by anchoring the silk string to the external carotid artery.

Three cases of traumatic carotid-cavernous fistula were treated by new surgical approach and these three cases were followed for 16 months, 15 months and 6 months respectively neurologically and angio-graphically. All patients are working actively without any complication.