Marginal sinus arteriovenous fistulas mimicking carotid. Enlarged cavernous sinus with a convex shape to the lateral. Pathophysiology of carotidcavernous fistulas in vascular. Traumatic carotid cavernous fistula accompanying basilar skull fracture. A, left external carotid angiogram, anteriorposterior view, showing shunt flow into the left cavernous sinus. This article is from june 2005 and may contain outdated material. Carotid cavernous fistulae may form following closed or penetrating head trauma, surgical damage, rupture of an intracavernous aneurysm, or in association with connective tissue disorders, vascular diseases and dural fistulas. Carotid cavernous fistula due to a ruptured intracavernous.
Increased pressure within the cs seems to be the mainstay of pathophysiology, although arterial steal and increased flow plays an important role. Treatment of carotid cavernous fistulas springerlink. Four cases in which the diagnosis of carotid cavernous fistula was made by using ct angiography are illustrated. Dural carotid cavernous fistulas dccfs constitute a rare condition caused by abnormal communications between meningeal branches of the internal or external carotid artery and the cavernous sinus, typically diagnosed in postmenopausal women. Direct spontaneous carotid cavernous fistula sccf is reportedly pathognomonic of veds. Selective angiography of the external carotid artery showing an indirect type d right carotid cavernous fistula. Ccfs are classified using the barrow classification. Carotid cavernous fistula carotid cavernous fistulas are a specific type of abnormal connection of the arteries directly into the venous system. Young men are at highest risk, as the major cause is head trauma.
V v halbach, r t higashida, g b hieshima, m reicher, d norman, t h newton. The main symptom is diplopia, caused by compression injury of the oculomotor nerves. Carotidcavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. A caroticocavernous fistula ccf may be due to either a direct connection between the cavernous ica and the cavernous sinus and present acutely, or due to an indirect connection via small branches of the ica, eca, or as in this case both. A carotid cavernous sinus fistula is an abnormal connection that forms between a carotid artery in your neck and the network of veins at the back of your eye. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the onyx embolic agent in the fistula. Author links open overlay panel mitsuru kuroi dds, phd chief. Looking for online definition of carotid cavernous sinus fistula in the medical dictionary. Historical, pathological, diagnostic and therapeutic data are discussed with the authors usual thoroughness. Many kinds of detachable balloon catheters including chinese. The differential diagnosis, therefore, depends upon neuroradiologic studies that include selective angiograms of the internal and external carotid systems.
Three cases of carotid artery fistulas have been reported, including two direct carotid cavernous fistulas and one external carotid artery fistula. We conducted a retrospective analysis of a monocentric veds cohort along with a literature. B, left internal carotid angiogram, lateral view, showing a dural arteriovenous fistula at the posterior cavernous sinus. But treatment success rates for these fistulas now approach 100 percent when the repairs are performed early by experienced. Ccf is an abnormal communication between carotid arterial system internal carotid artery ica or external carotid artery eca and cavernous sinus cs fig. Doctor answers on symptoms, diagnosis, treatment, and more. However, some are iatrogenic, happening during a neurosurgical or interventional neuroradiological procedure. Carotid cavernous fistulas ccfs are a rare but potentially devastating cause of orbital symptoms, visual loss, and periocular disfigurement.
We present one case of direct carotid cavernous fistula, which is the only reported case of this complication associated with microcompression gangliolysis. Carotid cavernous sinus fistula and aneurysmal rupture associated with fibromuscular dysplasia. Urgent treatment of severe symptomatic direct carotid. We evaluated drainage patterns of ccfs by digital subtraction angiography dsa and categorized drainage pathways according to their types and etiology. If they do rupture they most often lead to a ccf instead of bleeding into the subarachnoid space. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. This atypical clinical presentation may lead to misdiagnosis and inappropriate. Cannulation and complete embolization of the offending vessels during angiography proved unsuccessful, and so the patient underwent adjuvant. Urgent treatment of severe symptomatic direct carotid cavernous fistula caused by ruptured cavernous internal carotid artery aneurysm using highflow bypass, proximal ligation, and direct distal clipping.
Direct carotid cavernous fistula after trigeminal balloon. Endovascular treatment strategy for direct carotid cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. What is a carotid cavernous fistula doctor answers. A woman with a red eye from a carotidcavernous sinus. We conducted this study to understand the possible mechanisms of occurrence of sccf in this subset of patients. As arterial blood under high pressure enters the cavernous sinus, the normal venous return to the cavernous sinus is impeded and this causes engorgement of the draining veins, manifesting most dramatically as a.
A carotid cavernous sinus fistula should be considered in a patient with chronic red eye present longer than four weeks. Drainage is toward the ips and the contralateral ips through the intercavernous sinus. This paper focuses on the historical progression of our understanding of the condition and its symptomatologyfrom the initial hypothesis of ophthalmic artery aneurysm as the cause of pulsating exophthalmos to the recognition and acceptance of fistulas between the carotid arterial system and. On cranial mr imaging, one of the balloons was detected in the proximal portion of the superior ophthalmic vein and was deflated percutaneously with a 22gauge chiba needle under ct. Dexamethasone may be used while waiting for definitive diagnosis and treatment. Carotidcavernous and orbital arteriovenous fistulas. A carotidcavernous sinus fistula is an abnormal connection that forms between a carotid artery in your neck and the network of veins at the back of your eye. The characteristic clinical features seen in patients with ccfs are the sequelae of hemodynamic dysfunction within the cavernous sinus. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Jun 25, 2018 vascular ehlersdanlos syndrome veds is a rare condition characterized by connective tissue fragility. The fistula leads to a highpressure inflow of arterial blood into the venous sinuses, resulting in compression and damage to adjacent structures. Carotidcavernous fistula presenting with bilateral. A free powerpoint ppt presentation displayed as a flash slide show on id. Treatment of carotid artery cavernous sinus fistula.
The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. Highflow direct ccfs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. Spontaneous direct carotidcavernous fistula in an elderly. A ptient is described with a ruptured intracavernous aneurysm causing a ccf resulting in acute onset of. Dural carotid cavernous fistulas are usually treated via a transvenous approach through the inferior petrosal sinus. Clinical features of a carotid cavernous sinus fistula include tortuous corkscrew episcleral vessels, chemosis, asymmetric intraocular pressure, proptosis and an orbital bruit. The treatment of a carotid cavernous fistula ccf depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. Management of a rare complication of endovascular treatment. The conventional cerebral panangiography confirmed the diagnosis a direct carotid cavernous fistula ccf, with no evidence of ruptured aneurysm. This separates the blood flow of the carotid arteries from that of the veins.
In this paper, we report the case of an 88yearold woman who presented with a twomonth history of worsening visual symptoms and was subsequently found to have bilateral barrow grade d ccfs. Carotid cavernous fistula is an abnormal arteriovenous communication between the carotid artery or its branches and the cavernous sinus. Embolization of carotidcavernous fistula via direct. Carotid cavernous fistula an overview sciencedirect topics. Bilateral carotid cavernous fistulas ccfs are rare. Direct carotidcavernous fistula resulting from direct communication of the cavernous carotid artery and the cavernous sinus with resultant high velocity of blood flow most often results from trauma or from rupture of a preexisting aneurysm of the cavernous carotid artery. Meaning of carotid cavernous sinus fistula medical term.
Classification and treatment of spontaneous carotid cavernous sinus fistulas. Endovascular embolization represents the method of choice for the treatment of carotid cavernous fistulas ccfs. Venous drainage patterns in carotid cavernous fistulas. A carotidcavernous fistula is an abnormal communication between a carotid artery and the cavernous sinus.
As a result, the blood can drain properly from the eyes. A 30yearold woman with direct carotid cavernous fistula underwent endovascular treatment with detachable balloons via a transarterial route. Liang w, xiaofeng y, weiguo l, wusi q, gang s, xuesheng z. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low.
Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. In this retrospective study of 20 patients, we report. Marginal sinus fistulas msfs are uncommon vascular anomalies. Carotid cavernous fistulas ccf5 are abnormal communications between the carotid artery or its dural branches and the cavernous sinus. The potentially sightrobbing vascular abnormality known as the carotid cavernous sinus fistula ccf can masquerade as conjunctivitis or other common ocular conditions, which diminishes the chance for a speedy diagnosis. Carotidcavernous sinus fistula definition of carotid. Presentation and treatment of carotid cavernous aneurysms. This article is from march 2008 and may contain outdated material. Spontaneous arteriovenous fistula between dural branches of. Peng and others published carotid cavernous fistula presenting with bilateral abducens palsy find, read and cite all the research you need on researchgate. Occasionally, the dominant venous drainage is forced retrograde up the inferior petrosal sinus and into the cavernous sinus, causing chemosis, proptosis, and ocular hypertension, mimicking a carotid cavernous fistula.
The carotid artery, the main supply to the head, can establish a direct connection to the veins in the cavernous sinus lead to pronounced elevation of pressure in the veins which will dilate throughout the front of the head and can lead to a deadly leak. We report our experience using the endovascular technique in 24 patients harboring 25 ccfs treated between october 1994 and april 2010, with an emphasis on the role of detachable balloons for the treatment of direct ccfs. Ppt carotid cavernous fistula powerpoint presentation. The fistula was successfully treated angiographically. Intracavernous carotid artery aneurysms causing a carotid cavernous fistula ccf are rare. These fistulas usually result from some injury, like an automobile mishap or mugging. Abstract full text pdf carotid cavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. Endovascular embolization of carotidcavernous fistulas. The characteristic clinical features seen in patients with ccfs are. Of the 10 orbital arteriovenous shunts showing signs of dural fistulas, the features disappeared in 8 cases, although after a much longer followup period than for the typical dural carotid cavernous sinus fistulas.
Peng, md, department of neurology, yale school of medicine, 15 york st, llci 910, po box 208018, new haven, ct 06520. The diagnosis was confirmed by digital subtraction angiography in all four instances. The patient returned with diplopia 1 year after therapy. Carotid cavernous fistula trh9 3 treatment in acute setting of vision loss cn paralysis, glucocorticoids e. Treatment of a traumatic carotidcavernous fistula by the. Traumatic carotidcavernous fistula associated with a. A surgical approach to the cavernous portion of the.
May 15, 2001 from 1986 to the end of 1998, 482 cases of traumatic carotid cavernous fistula tccf were treated by means of intravascular embolisation technique. This is another wellwritten book from the pen of dr. Department of neurological surgery, university of virginia 2. Treatment of carotid cavernous fistulas request pdf. Cureus bilateral carotidcavernous fistulas treated with. Two thirds of the patients underwent carotid artery surgery because of the fistula. Direct carotid cavernous fistula ccf is an uncommon but well known complication of head trauma. The diagnostic angiogram was performed to evaluate the supply and drainage of the fistula. Based on this classification, our case belongs to type a ii. Carotid cavernous fistula was one of the first intracranial vascular lesions to be recognized. Feb 10, 2017 these findings are consistent with a carotid cavernous fistula. In most instances, endovascular treatment is preferred. Ccfs are classified into two main types based on their pathophysiology, direct type a and indirect type bd 1, 2, as shown in figure 1. To our knowledge, this is the first report of the ct angiographic appearance of carotid cavernous fistulas.
Carotidcavernous fistula knowledge for medical students. A ccf can be due to a direct connection between the cavernous segment of. Caroticocavernous fistula radiology reference article. Diagnosis and management of carotid cavernous fistulas. A ccf can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. These lesions may be classified based on the following.
Carotid cavernous fistula patients typically present with proptosis, elevated intraocular pressure, prominent tortuous conjunctival vessels, and sometimes headache. Carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. These aneurysms usually cause neurological symptoms due to gradual expansion without rupture. Symptoms and signs are usually related to orbital congestion caused by retrograde filling of the ophthalmic veins from the cavernous sinus 3,4.
Interventional treatment of carotid cavernous fistula. Surgical exposure and direct access to the superior ophthalmic vein have been previously described in situations in which conventional transvenous access, including the inferior petrosal sinus, is not possible. Treating a carotid cavernous fistula with embolization involves placing small platinum coils where the abnormal connection is. Carotidcavernous fistula an overview sciencedirect topics. Barrow dl, spector rh, braun if, landman ja, tindall sc, tindall gt. A carotid cavernous fistula ccf is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as. The initial signs and symptoms and subsequent course of 74 patients with carotid cavernous fistula were evaluated in relation to the prognosis for final visual acuity. A carotid cavernous sinus fistula ccf is an arterialvenous fistula between the internal carotid artery and cavernous sinus, and can be classified as either direct or indirect.
Typea fistulas rarely resolve spontaneously because of high flow fistula. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. Carotidcavernous fistula ccf differential diagnoses. A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. We report successful transvenous treatment of direct carotid cavernous fistula in a patient with ehlersdanlos syndrome type iv using a novel tripleoverlay embolization tailored technique without the need for arterial puncture, which is known to be highly risky in this patient group. These signs and symptoms are clinically indistinguishable from those of the more common fistula between the internal carotid artery and the cavernous sinus. Moreover, others arise from a spontaneous rupture of a carotid artery aneurysm in the cavernous sinus.
34 775 646 1077 59 725 1135 496 1616 1247 1247 897 115 507 1527 943 489 1420 162 1189 1164 432 918 1392 1426 866 1211 1227 68 496 1193 1587 1621 826 935 177 541 389 1499 239 966 1157 1155 1479 971