Endovascular treatment of carotid cavernous fistulas ccfs via a transvenous approach is standard, but in rare cases this approach is challenging due to absence or thrombosis of the commonly used venous routes. A carotid cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. Classification and treatment of spontaneous carotidcavernous sinus fistulas. Caroticocavernous fistula radiology reference article. This article is from june 2005 and may contain outdated material. Carotidcavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. 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. Carotid cavernous fistulas ccfs are a rare but potentially devastating cause of orbital symptoms, visual loss, and periocular disfigurement. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Carotid cavernous fistula due to a ruptured intracavernous. 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. The diagnosis was confirmed by digital subtraction angiography in all four instances. Pdf interventional treatment of carotid cavernous fistula.
Traumatic carotid cavernous fistula associated with a mandibular fracture. Carotid cavernous fistulas have been classified according to the hemodynamic properties, etiology, or anatomy of the fistula. These aneurysms usually cause neurological symptoms due to gradual expansion without rupture. The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. As a result, the blood can drain properly from the eyes. Diagnosis and management of carotid cavernous fistulas. Four cases in which the diagnosis of carotid cavernous fistula was made by using ct angiography are illustrated. If they do rupture they most often lead to a ccf instead of bleeding into the subarachnoid space. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus.
Patients present with proptosis, ecchymosis redness, and pain around the affected eye. 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. Treatment of carotid cavernous fistulas northwestern scholars. Carotid cavernous fistula is an abnormal arteriovenous communication between the carotid artery or its branches and the cavernous sinus. 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 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. Transarterial platinum coil embolization of carotid. A 61yearold woman presented with a symptomatic ccf with all but one of the venous access routes to the ccf thrombosed, leaving an engorged superficial middle cerebral vein smcv as. Clinical features of a carotidcavernous sinus fistula include tortuous corkscrew episcleral vessels, chemosis, asymmetric intraocular pressure, proptosis and an orbital bruit. Traumatic carotid cavernous fistula accompanying basilar skull fracture. Carotid cavernous fistulae ccfs are a rare complication of head trauma, with potentially serious consequences. We report the case of a 45yearold male patient who presented with posttraumatic ccf 2 months after sustaining a head injury.
Urgent treatment of severe symptomatic direct carotid. Carotid cavernous fistula patients typically present with proptosis, elevated intraocular pressure, prominent tortuous conjunctival vessels, and sometimes headache. Carotid cavernous fistula carotid cavernous fistulas are a specific type of abnormal connection of the arteries directly into the venous system. An initial cerebral angiogram revealed a large left direct carotid cavernous fistula. A carotidcavernous fistula ccf is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as. 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. These lesions may be classified based on the following.
A, right internal carotid injection, lateral projection, shows carotid cavernous fistula arising from anterior inferior carotid siphon, with drainage to the superior ophthalmic vein. Carotid cavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. Treating a carotid cavernous fistula with embolization involves placing small platinum coils where the abnormal connection is. Intracavernous carotid artery aneurysms causing a carotid cavernous fistula ccf are rare. Treatment of carotid cavernous fistula secondary to rupture of a giant intracavernous carotid aneurysm 22 june 2016 interventional neuroradiology, vol. Traumatic carotidcavernous fistula associated with a. Barrow dl, spector rh, braun if, landman ja, tindall sc, tindall gt. 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. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. Hemicranial coughinduced headache as a first symptom of a. 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.
The left hemisphere filled through the anterior communicating artery. A cavernous carotid fistula ccf is an abnormal communication between the carotid artery and the cavernous sinus cs. Direct carotid cavernous fistula after trigeminal balloon. Interventional treatment of carotid cavernous fistula. This separates the blood flow of the carotid arteries from that of the veins. The anatomy of the lesion can vary, ranging from fistulas connecting the internal carotid artery or external carotid artery to the cs. Images in clinical medicine from the new england journal of medicine carotid cavernous fistula.
A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. This article is from march 2008 and may contain outdated material. A carotid cavernous fistula ccf is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as either direct or dural. Carotidcavernous fistula was one of the first intracranial vascular lesions to be recognized. The etiology, classification, clinical presentation, complications, and intravascular routes to image and treat carotid cavernous fistulas percutaneously are described. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. Jan 23, 2017 a carotidcavernous sinus fistula should be considered in a patient with chronic red eye present longer than four weeks. To our knowledge, this is the first report of the ct angiographic appearance of carotid cavernous fistulas. Angiographic evidence of arterial steal from the left hemisphere was noted, with reversal of flow down the internal carotid artery ica to the fistula.
Cavernouscarotid fistula presenting with intracerebral. Author links open overlay panel mitsuru kuroi dds, phd chief. A traumatic carotid cavernous fistula ccf connecting the internal carotid artery directly to the cavernous sinus is a potentially lifethreatening condition requiring urgent treatment, particularly in the presence of a pseudoaneurysm. 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. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. Many kinds of detachable balloon catheters including chinese.
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. A woman with a red eye from a carotidcavernous sinus fistula. Carotid cavernous fistulas are abnormal vascular shunts, allowing blood to flow either directly or indirectly from the carotid artery into the cavernous sinus. The fistula was successfully treated angiographically.
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