Carotid artery-sygmoid sinus fistula : a rare complication of gunshot wound on the base of the cranium

• Published in: Neurosurgical review Vol. 22; no. 2-3; pp. 121 - 123
• Main Authors: VIEIRA BOTELHO, R, ROMERO, P. C, MACHADO COELHO, R. V, FRANCA FONTOURA, E. A
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-10-1999
• Subjects: Adult; Arteriovenous Fistula - diagnostic imaging; Biological and medical sciences; Brain Injuries - diagnostic imaging; Carotid Artery Injuries - diagnostic imaging; Carotid Artery, External - diagnostic imaging; Cerebral Angiography; Cranial Sinuses - diagnostic imaging; Cranial Sinuses - injuries; Fatal Outcome; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Tropical medicine; Wounds, Gunshot - diagnostic imaging; Human; Nervous system diseases; Radiodiagnosis; Angiography; Diseases of the osteoarticular system; Cardiovascular disease; Male; Trauma; Wound; Cerebral disorder; Venous disease; Arterial disease; Vascular disease; Case study; Arteriovenous aneurysm; Carotid; Central nervous system disease; Young adult; Skull disease; Complication; Fire arm; Diagnosis; Base of the skull
• ISSN: 0344-5607; 1437-2320
• DOI: 10.1007/s101430050044

Vascular lesions without clinical manifestation may occur in cranial-facial wounds produced by bullets that course the base of the cranium. This work describes a rare kind of vascular complication in cranial-facial gunshot wound. The authors present the case of a patient, the victim of a cranium-maxillary gunshot wound. Carotid angiography revealed a carotid-sygmoid sinus fistula that filled the sygmoid and transverse sinuses, concomitant to the arterial angiographic phase. A direct communication between the external carotid artery and the sygmoid sinus was disclosed. We are not aware of any other description of this vascular complication in cranial gunshot wound. It is important to recognize this kind of complication in cases of cranial-facial gunshot wound, because new factors harmful to the brain perfusion systems are introduced, in addition to the alterations to venous return and intracranial pressure, caused by the primary trauma. The new non-invasive vascular diagnostic methods are proving useful in filling the gap left by arteriography, which is no longer used in these cases.