뇌지주막하 출혈 환자에서 후교통동맥 동맥류를 동반한 외상성 경동맥 해면 정맥동루에서 대한 뇌혈관 중재술을 통한 치료에 대한 증례보고

초록

PURPOSE : There are very difficult to determination of origin of subarchnoid hemorrhage(SAH) in case of traumatic carotid cavernous fistular(CCF) accompanied with intracranial aneurysm. We experienced rare case of SAH patient who had CCF and intracranial aneurysm and treated with endovascular technique. We reported this case with literature reviews MATERIALS AND METHODS : A 45 years old man was visit to emergency medical center(EMC) due to passenger traffic accident(TA) with severe head trauma. Brain computed tomography was performed and demonstrated massive subarachnoid hemorrhage in bilateral cerebral hemisphere especially in basal cistern and extended to sylvian cistern. To confiremed origin of SAH, we checked CT angiography and revealed posterior communicating aneurysm and cavernous ICA stenosis, same side. Even though lack of main lesion, we decided treat to two lesions with endovascular coil compaction, simultaneously. In the procedure, we confirmed left p-com aneurysm and ICA dissection along the cavernous portion and CCF was treated with stent assisted embolization partially and p-com aneurysm was obliterated with GDC coil. After embolization we confirm successfully oblertated with preservation of the parent artery. But 6 days after admission, the patient expired due to severe brain swelling. RESULTS : Both CCF and intracranial aneurysm were suitable for endovascular treatment, separately. But in case of accompanied each cases, many physicians were confused to origin and choosen method of treatment. Endovascular treatment was very good way of management of like this cases. Because endovascular treatment give a benefits like diagnosis and lesion obliteration at the same time. CONCLUSION : Our case was very rare but should keep in mind to treatment modalities. Endovascular treatment is the suitable technique like this complicated lesion.