Cerebellar Hemorrhage due to a Direct Carotid–Cavernous Fistula after Surgery for Maxillary Cancer.
10.3340/jkns.2015.1206.001
- Author:
Yoshinobu KAMIO
1
;
Hisaya HIRAMATSU
;
Mika KAMIYA
;
Shuhei YAMASHITA
;
Hiroki NAMBA
Author Information
1. Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. kamio880@hotmail.com
- Publication Type:Case Report
- Keywords:
Direct CCF;
Superior petrosal sinus;
Cerebellar hemorrhage
- MeSH:
Cavernous Sinus;
Cerebral Hemorrhage;
Consciousness;
Constriction, Pathologic;
Drainage;
Female;
Fistula*;
Hemodynamics;
Hemorrhage*;
Humans;
Magnetic Resonance Angiography;
Middle Aged;
Veins;
Venous Pressure
- From:Journal of Korean Neurosurgical Society
2017;60(1):89-93
- CountryRepublic of Korea
- Language:English
-
Abstract:
Infratentorial cerebral hemorrhage due to a direct carotid–cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus.
