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DOI: 10.1055/s-2007-998740
Eine seltene Komplikation der Septumoperation: Arteria carotis interna-sinus cavernosus-Fistel
A rare Complication of a Septum Operation: Internal Carotid Artery-Sinus Cavernosus FistulaPublication History
Publication Date:
29 February 2008 (online)
Zusammenfassung
Zu den bekannten Komplikationen bei der Septumplastik zählen die Perforation, das Hämatom, die Sattelnase, Gefühlsstörungen, Liquorrhoe und Geruchsstörungen. Am Beispiel einer Fistel zwischen Sinus cavernosus und Arteria carotis interna wird auf eine seltene, aber schwerwiegende Gefahr bei diesem Eingriff aufmerksam gemacht. Die anatomischen Gegebenheiten werden erläutert und die möglichen Verletzungswege werden aufgezeigt.
Summary
Perforation, haematoma, a saddle nose, dysaesthesia, liquorrhoea and hyposmia are among the most common complications in septum plasties. A case history points out the danger of a fistula between the sinus cavernosus and the arteria carotis interna during this operation.
A patient developed heavy nose bleeding during a septum plasty. A protrusio bulbi, a binocular deterioration in visual acuity, a pulsating tinnitus and a hyperaemic nose appeared postoperatively. By means of angiography of the arteria carotis interna the suspected diagnosis of an AV fistula was confirmed. The fistula was occuled in local anaesthesia by a radiopaquefilled micro-balloon.
The possible direct approach using an instrument via the transseptal-transsphenoidal access and the indirect method of injury by breaking out one of the insufficiently mobilised spurs of the lamina perpendicularis and its extension, the dislocated septum interspenoidalis, are described and demonstrated by graphic representations.