Carotidcavernous fistula may result from the down fracture of the maxilla or the pterygoid osteotomy, thus injuring the internal carotid artery. Pdf carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Carotid cavernous fistula can be effectively treated by occluding the fistula with transarterially deployable detachable balloons with preservation of the internal carotid artery. Doctor answers on symptoms, diagnosis, treatment, and more. Traumatic carotidcavernous sinus fistula with delayed. What is a carotid cavernous fistula doctor answers. This article is from june 2005 and may contain outdated material. 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.
In most instances, endovascular treatment is preferred. Four cases in which the diagnosis of carotidcavernous fistula was made by using ct angiography are illustrated. Ophthalmology department, pelotas federal university ufpel medical school pelotas rs, brazil. Ccfs are classified based on the arterial system involved, hemodynamics, and etiology. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. A direct fistula is due to direct communication between the intracavernous internal carotid artery and the surrounding cavernous sinus. May 15, 2001 traumatic carotid cavernous fistula tccf arises from head injury and results in a direct shunt between the internal carotid artery ica and the cavernous sinus, which usually occurs in young men. Symptoms are often abrupt in onset and rapidly progressive, and ccf requires immediate treatment if there is progressive visual impairment. External manual compression of the ipsilateral carotid artery and. Cannulation and complete embolization of the offending vessels during angiography proved unsuccessful, and so the. Signs and symptoms are related to the compression of structures within the cavernous sinus, including the.
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. To determine the vascular approach for effective management of the fistula. We describe a case of direct carotidcavernous fistula following treatment of intracavernous carotid aneurysm with a silk flowdiverter stent alone. Endovascular treatment strategy for direct carotid cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. Treatment of carotid cavernous fistulas request pdf. Carotidcavernous fistula and carotid artery aneurysm sonoworld. Ruptured cavernous sinus aneurysms causing carotid.
After ct scan and angiography, a direct obliteration of the cavernous sinus was performed, with good recovery and regression of the clinical signs. 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 fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. Patients may have double vision as the nerves that control the eye are affected or vision. To our knowledge, this is the first report of the ct angiographic appearance of carotid cavernous fistulas. The fistula was successfully treated angiographically. These lesions may be classified based on the following. There are a number of causes, however, aneurysm rupture and trauma are by far the most common. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Study conducted at the pelotas federal university ufpel pelotas rs, brazil.
Images in clinical medicine from the new england journal of medicine carotid cavernous fistula. 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. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. 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. To our knowledge, this is the first report of the ct angiographic appearance of carotidcavernous fistulas.
The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. Direct carotidcavernous fistula following intracavernous. After ct scan and angiography, a direct obliteration of the cavernous sinus was performed, with good recovery and. 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. Glaucoma secundario a fistula carotidocavernosa secondary glaucoma following carotid cavernous fistula rafael aguiar carvalho 1, henrique silva delloiagono, alessandro adad jammal1,graziela massa resende2, helia soares angotti3 1 residence program in ophthalmology, universidade federal do triangulo mineiro, uberaba, mg, brazil. 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. Apr 28, 20 the initial angiographic evaluation can be used to obtain the following information. Several cranial nerves, including the third, fourth, sixth, and the ophthalmic and maxillary branches of the fifth cranial nerves, pass through each cavernous sinus.
A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that. Recurrent neurosensory macular detachment in carotidcavernous fistula desprendimiento neurosensorial macular recurrente en fistula carotidocavernosa. Bilateral carotid cavernous fistulas ccfs are rare. Endovascular treatment of carotid cavernous fistulae. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Manual compression of the ipsilateral carotid artery and jugular vein can help. In the event that the balloon cannot be fed through the fistula via a transarterial approach, detachable platinum coils are often deployed electrolytically via a.
Discussion carotid cavernous fistulae represent a direct communication between the arterial flow of the carotid siphon and the venous compartment of the cavernous sinus 1, 2, 3. 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. Fistula carotido cavernosa postraumatica 270 youtube. Classification and treatment of spontaneous carotidcavernous sinus fistulas. The definitive diagnosis is established by cerebral arteriography. Carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. It had a lowflow and a carotidcavernous fistula was suspected fig. Carotid cavernous fistulas are infrequent vascular malformations that generate a pathological arteriovenous shunt, which compromises ocular function. A healthy 18yearold man was in a motor vehicle accident and received. The definitive diagnosis is established by cerebral. Fractures or the shearing forces of severe head trauma.
However, its invasive nature limits its use in followup. Cannulation and complete embolization of the offending vessels during angiography proved unsuccessful, and so the patient underwent adjuvant. A study on the incidence of traumatic carotid cavernous fistula in the patients with basilar skull fracture and the prognostic analysis about traumatic carotid cavernous. Ctaguided outflowtargeted embolization of direct carotid cavernous fistula duration. Ctaguided outflowtargeted embolization of direct carotidcavernous fistula duration. Ocular involvement is irreversible in most cases so identification of this condition is considered a clinical challenge that determines the visual prognosis. Traumatic carotid cavernous fistula accompanying basilar skull fracture.
The aim of this work is to illustrate the value of the study with transcranial doppler ultrasound for. The initial angiographic evaluation can be used to obtain the following information. 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. Treatment of carotid cavernous fistulas springerlink. Ccfs arise from abnormal connections between the carotid arteries and the cavernous sinus. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. 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. Patients present with proptosis, ecchymosis redness, and pain around the affected eye.
The diagnosis was confirmed by digital subtraction angiography in all four instances. Ccfs are classified based on hemodynamics high flow or low flow, pathogenesis spontaneous. The traumatic fistulae occur more frequently, 75% of cases, appearing after car accidents or after. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. In direct fistulas there is an abnormal communication between the internal carotid artery and the cavernous sinus. Treatment of carotid cavernous fistulas northwestern scholars. Caroticocavernous fistula radiology reference article. Treatment of carotid cavernous fistulas northwestern.
Carotid cavernous fistula carotid cavernous fistulas are a specific type of abnormal connection of the arteries directly into the venous system. 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. A carotid cavernous fistula ccf is the result of an abnormal vascular connection between the internal carotid artery ica or external carotid artery eca and the venous channels of the cavernous sinus. This paper concerns 17 cases of carotidcavernous fistula, 16 of which are from the neurosurgical institute in santiago in chile and one from the general hospital in mexico. 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. Oct 28, 2015 in patients in whom absolutely no runoff is demonstrated, carotid sacrifice at the level of the carotid cavernous fistula can be considered, if necessary, to close the fistula. Recurrent neurosensory macular detachment in carotid.
A case of carotid cavernous fistula with contralateral proptosis is reported, in a 74 year old man, who suffered a head trauma five months previously. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. Aneurysms of the cavernous segment of the internal carotid artery usually become symptomatic by mass effect on the adjacent cranial nerves, causing ophthalmoplegia and, sometimes, decreased vision or trigeminal neuralgia. May 22, 2015 sindrome del piramidal o falsa ciatica. Ruptured cavernous sinus aneurysms causing carotid cavernous fistula. Fistula carotidocavernosa asociada al parto topic of. The internal carotid artery ica lies within the cavernous sinus bilaterally and is firmly suspendedat its verticallyorientedentranceand exit points. Five patients aged 1733 years with traumatic carotidcavernous fistulas ccfs were treated by antegrade embolization through a superior ophthalmic vein approach, using cutdown technique on the upper eyelid.
Cureus bilateral carotidcavernous fistulas treated with. Request pdf treatment of carotid cavernous fistulas the treatment of a carotid cavernous fistula ccf depends on the severity of the clinical symptoms, its angiographic characteristics, and. Create marketing content that resonates with prezi video. Carotidcavernous fistula fistula carotidocavernosa scielo espana. Ruptured cavernous sinus aneurysms causing carotid cavernous. Case report a 39yearold woman complained of right hemifacial pain related to an aneurysm of the right intracavernous carotid artery revealed by mri. Four cases in which the diagnosis of carotid cavernous fistula was made by using ct angiography are illustrated. In patients in whom absolutely no runoff is demonstrated, carotid sacrifice at the level of the carotidcavernous fistula can be considered, if necessary, to close the fistula. To determine the site and type of carotidcavernous fistula by the means of diagnostic conventionaldigital subtraction angiography. Endovascular treatment of carotid cavernous sinus fistula. Classification and treatment of spontaneous carotid cavernous sinus fistulas. Fistula carotideocavernosa carotidcavernous fistula core. This article is from march 2008 and may contain outdated material.
Dural carotidcavernous fistulas neurosurgery clinics of north. Needless to say, this treatment also depends on the collateral vessels and the patients ability to tolerate intracavernous carotid artery sacrifice. A study on the incidence of traumatic carotid cavernous fistula in the patients with basilar skull fracture and the prognostic analysis about traumatic carotid cavernous fistula. Carotidcavernous fistula abstract the carotidcavernous fistula ccf is an abnormal connection between the carotid artery and the cavernous sinus that can be spontaneous in 25% of the cases or acquired in 75% of the cases, mainly with a traumatic origin. Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Diagnosis and management of carotid cavernous fistulas.
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