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Successful Treatment Using Detachable Coils for Traumatic Carotid Cavernous Fistula as a Complication of Transsphenoidal Surgery for a Pituitary Adenoma : a case report Nobusuke KOBAYASHI 1 , Takumi ABE 1 , Hajime FURUYA 1 , Kenji DOHI 1 , Motohiko SHIMAZU 1 , Ken SASAKI 1 , Hitoshi IZUMIYAMA 1 , Kiyoshi MATSUMOTO 1 , Seido OHKI 2 , Shigeru NEMOTO 3 1Departments of Neurosurgery, Showa University School of Medicine 2Departments of Otorhinolaryngology, Showa University School of Medicine 3Department of Neurosurgery, Tokyo Police Hospital Keyword: traumatic carotid cavernous fistula , carotid artery injury , transsphenoidal surgery , pituitary adenoma , detachable coil pp.167-171
Published Date 2000/2/10
DOI https://doi.org/10.11477/mf.1436901850
  • Abstract
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We report a case of a patient with traumatic carotid cavernous fistula (CCF) caused by transnasal-trans-sphenoidal surgery, who was successfully treated using detachable coils. A 47-year-old man was admitted to our hospital because of severe headache. He was confirmed to have a nonfunctioning pituitary adenoma with presellar-type sphenoid sinus. Cerebral angiography initially disclosed no vascular lesions. A transnasal-transsphenoidal adenomectomy was performed. When the anterior wall of the sphenoid sinus was dissected with a chisel, the chisel deeply stuck into the posterolateral partof the sinus. Profuse arterial bleeding was observed through the sphenoid sinus. The bleeding was stopped easilyby compression and packing with bone wax. The operation was continued, the cellar floor was opened widely and the tumor was removed subtotally. The medial wall of the cavernous sinus was intact. Histological examination re-vealed a pituitary adenoma. Immediately after surgery, the patient noticed a bruit. He developed chemosis and abducent palsy on the right side. Cerebral angiography displayed a high-flow CCF, which was attri-buted to the carotid artery injury caused by the transnasal-transsphenoidal surgery. The CCF disappeared after two-staged embolization using detachable coils, 1st transvenous and 2nd transarterial. Ten months la-ter, cerebral angiography showed persistent occlusion of the fistula, and the patient experienced no tumor recurrence. It is suggested that drilling is a safer procedure than using a chisel for dissection of a sphenoid sinus with incomplete pneumatization. Endovascular treatment using detachable coils proved useful to manage the CCF, an unusual complication of transsphenoidal surgery.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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