ABSTRACT
OBJECTIVES: In indirect carotid-cavernous sinus fistulas (CCF), abnormal connections exist between tiny dural branches of the external and/or internal carotid system and the cavernous sinus. Usually this kind of fistula occurs spontaneously and is characterized by a low shunt volume. Alternative vascular approaches for embolization are required when standard interventional neuroradiological access via arterial or transfemoral venous routes is not feasible. PATIENTS AND METHODS: Two symptomatic patients with indirect CCFs are described. Transarterial and transfemoral venous approach was unsuccessful or resulted in incomplete occlusion of the CCF. Therefore, the superior ophthalmic vein (SOV) was surgically exposed and retrograde catheterized to allow the delivery of platinum coils to the fistula point via a microcatheter. RESULTS: Complete fistula obliteration was accompanied by recovery of the clinical symptoms. CONCLUSION: The surgical SOV approach might be sufficient when standard neuroradiological procedures do not succeed. The technique is safe and effective when performed by an interdisciplinary team.
Subject(s)
Carotid-Cavernous Sinus Fistula/surgery , Cavernous Sinus/surgery , Embolization, Therapeutic/methods , Neurosurgical Procedures/methods , Vascular Surgical Procedures/methods , Veins/surgery , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Artery, Internal/surgery , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Carotid-Cavernous Sinus Fistula/pathology , Catheterization/standards , Cavernous Sinus/diagnostic imaging , Cavernous Sinus/pathology , Cerebral Angiography , Diplopia/etiology , Diplopia/physiopathology , Diplopia/surgery , Embolization, Therapeutic/instrumentation , Female , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Neurosurgical Procedures/instrumentation , Orbit/anatomy & histology , Orbit/surgery , Patient Care Team , Platinum , Prostheses and Implants/standards , Treatment Outcome , Vascular Surgical Procedures/instrumentation , Veins/anatomy & histologyABSTRACT
The haemodynamic effects of halothane nitrous oxide anaesthesia were studied in 15 children aged 4-13 using measurements of heart rate, blood pressure and impedance cardiography. The preinduction (control) measurements were compared with measurements obtained one minute after inhalation of nitrous oxide and oxygen, at the beginning of the stage of excitation, at the beginning of the stage of tolerance and after the injection of 0.02 mg/kg atropine. During the induction period blood pressure decreased significantly, while heart rate remained unchanged. Cardiac output was significantly decreased at the stages of excitation and tolerance. Virtually no change in total peripheral resistance occurred. After atropine significant increases in heart rate, mean arterial blood pressure and total peripheral resistance were measured. Cardiac output was increased compared with the pre-atropine values, but not with the control value. Impedance cardiography is a useful non-invasive method of measuring changes of stroke volume during paediatric anaesthesia.
