A sinus cavernosus szindróma egyoldalú ophthalmoplegia, autonóm diszfunkció és a nervus trigeminus ophthalmicus vagy maxillaris ága szenzoros kiesésének kombinációja. Fejsérülést követően sinus cavernosus szindróma jelentkezése esetén mindenképpen gondoljunk a dissectiós eredetű aneurysma lehetőségére. Vérzett aneurysmák mellett a ’silent’ intracranialis aneurysmákat is kezelnünk kell, ha kompressziós tüneteket okoznak. Esetismertetésünkben egy 23 éves nőbeteg sikeres kezelését mutatjuk be, aki esés során eszméletét vesztette, majd azonnal jobb oldali ptosis, ophthalmoplegia és arc területi érzéskiesés jelentkezett. Az angiográfia a jobb arteria carotis interna sinus cavernosus szakaszán dissectiós aneurysmát igazolt, melyet a sérülést követő 6. napon áramlásmódosító sztenttel kezeltünk. A beavatkozás szövődménymentesen zajlott, gyors és teljes radiológiai és klinikai gyógyulást eredményezett. Esetismertetésünk is megerősíti azt a metaanalíziseken alapuló tényt, hogy az arteria carotis interna sinus cavernosus szakaszán jelentkező dissectiós aneurysma áramlásmódosító sztenttel biztonságosan és sikeresen kezelhető. Ha a kezelés minél korábban elvégezhető, akkor a sinus cavernosus szindróma minden tünete rendeződik, az azonos oldali ophthalmoplegia és az arc érzéskiesése néhány napon belül tökéletesen gyógyulhat. Orv Hetil. 2023; 164(52): 2074–2078.
Cavernous sinus syndrome is a combination of unilateral ophthalmoplegia, autonomic dysfunction and sensory loss of the ophthalmic or maxillary branch of the trigeminal nerve. In the case of cavernous sinus syndrome after a head injury, we should consider the possibility of a dissecting aneurysm. In addition to ruptured aneurysms, silent intracranial aneurysms must also be treated if they cause compression symptoms. In our case report, we present a 23-year-old female patient who lost consciousness during a fall, and immediately developed right-sided ptosis, ophthalmoplegia and loss of facial sensation. Angiography confirmed a dissection aneurysm of the right internal carotid artery at the cavernous sinus, which was treated with a flow diverter on the 6th day after the injury. The intervention was uncomplicated and resulted in rapid and complete radiological and clinical healing. Our case report confirms the fact, based on meta-analyses, that dissection aneurysm occurring at the cavernous sinus section of the internal carotid artery can be safely and successfully treated with a flow diverter. If the treatment is carried out as early as possible, all the symptoms of the cavernous sinus syndrome can be resolved, and the ipsilateral ophthalmoplegia and loss of facial sensation can be completely cured within a few days. Orv Hetil. 2023; 164(52): 2074–2078.
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