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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Delayed Pontomesencephalic and Cervical Cord Venous Drainage Followed by Contralateral Carotid-Cavernous Fistula
Steven Tandean1,2, Harsan Harsan3, Andre Marolop Pangihutan Siahaan1,2
1Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Abstract:
A 24-year-old male was admitted with progressive cervical hypesthesia, tetraparesis, dyspnea, and a history of craniofacial fracture. Spinal magnetic resonance imaging (MRI) showed brainstem edema extending to the thoracic spine with multiple prominent perimedullary vascular structures. Cerebral digital-substraction angiography revealed Barrow type A carotid-cavernous fistula. Total occlusion with preservation of internal carotid artery flow was achieved using 1 detachable balloon and 6 coils. Postoperatively, immediate respiratory recovery, gradual extremities strength improvement, and right abducens nerve palsy were found. One month follow-up cervical MRI showed good recovery of spinal cord edema and perimedullary veins.
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