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Szabó I, Zag L, Csontos A, Takács IF, Szikora I. Patient with a spontaneously evolving carotid cavernous fistula in the emergency department. IDEGGYOGYASZATI SZEMLE 2017; 70:63-67. [PMID: 29870194 DOI: 10.18071/isz.70.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background - Approximately 2% of patients admitted to the emergency department present with headache, which is often associated with vomiting, ocular pain, and earache. In rare cases, the presence of an abnormal communication between a cavernous sinus and the carotid arterial system that creates a carotid cavernous fistula is the main cause of these symptoms. Case presentation - A 32-year-old woman presented at the emergency department with unilateral headache associated with earache on the same side, and pulsating tinnitus. On examination, we observed unusual appearance of our patient (small stature, unusually visible skin, lobeless ears). In the first 5 hours of our observation no neurological symptoms had been present, but after a severe vomiting, exophthalmos, subconjunctival suffusion and moderate ptosis developed. First, regarding the initial general symptoms, otorhinolaryngologist assessed the patient, and did not find any abnormality. Further, we ordered computed tomography and consulted a neurologist. Despite of the negative results we continued the observation because her symptoms did not improve. After appearance of neurological symp-toms, carotid cavernous fistula was suspected. Magnetic resonance imaging and ophthalmologist consultation verified the diagnosis. For therapy, she was transferred to interventional neuroradiology. Because of the unusual appearance and carotic cavernous fistula, we ordered genetic examination. This indicated the presence of Ehlers-Danlos syndrome type IV in the background. The first major manifestation of the syndrome was observed at our department. Conclusions - Carotid cavernous fistula is an uncommon diagnosis in the emergency department; however, the early recognition of symptoms and early treatment can prevent further consequences of this potentially severe condition.
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Mousa A, Bernheim J, Lyon R, Dayal R, Hollenbeck S, Henderson P, Clair D, Kent KC, Faries PL. Postcarotid Endarterectomy Pseudoaneurysm Treated with Combined Stent Graft and Coil Embolization. Vasc Endovascular Surg 2016; 39:191-4. [PMID: 15806281 DOI: 10.1177/153857440503900209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pseudoaneurysm formation is a rare complication following carotid endarterectomy (CEA); however, its occurrence is associated with significant risk of morbidity. The patient in this report presented 2 years following CEA with headache and lateral neck mass. The diagnosis of a 3.5 x 3.0 cm carotid artery bifurcation pseudoaneurysm was made by using magnetic resonance angiography (MRA). Endovascular exclusion of the aneurysm was accomplished with coil embolization of the external carotid artery followed by deployment of a 7 x 50 mm wall stent graft into the common carotid artery-internal carotid artery (CCA-ICA). The patient's symptoms improved and at 6-months postexclusion, duplex ultrasound demonstrated a significant reduction in pseudoaneurysm size. This case highlights the feasibility and safety of using endovascular techniques in the treatment of post-CEA pseudoaneurysm.
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Ghodasra DH, Katowitz JA, Liu GT, Binenbaum G. Indirect internal carotid-cavernous fistula in infancy. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e11-3. [PMID: 25751239 DOI: 10.3928/01913913-20150303-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/29/2015] [Indexed: 11/20/2022]
Abstract
A 4-month-old male infant with proptosis and episcleral injection initially thought to have orbital inflammation was found to have an indirect carotid-cavernous sinus fistula. He was treated conservatively without worsening of symptoms. The authors report the first case of indirect carotid-cavernous sinus fistula in an infant originating from the internal carotid artery.
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Oumellal J, Bekaert O, Gallas S, Leguerinel C, Palfi S, Derkaoui F, El Fatemi N, Gana R, Elmaquili MR, Elabbadi N. Fistules carotido-caverneuses post-traumatiques à propos d’un cas et revue de la littérature. Pan Afr Med J 2015; 21:290. [PMID: 26587139 PMCID: PMC4634034 DOI: 10.11604/pamj.2015.21.290.6210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 06/16/2015] [Indexed: 11/24/2022] Open
Abstract
Les auteurs rapportent une observation clinique d'une fistule carotidocaverneuse survenue à la suite d'un traumatisme craniofaciale grave. Une exophtalmie unilatérale pulsatile et asymétrie des 2 sinus caverneux au scanner ont permis de suspecter le diagnostic. Une artériographie a permis de confirmer ce diagnostic, avec embolisation couronnée de succès chez ce malade, mais l’évolution est défavorable sur le plan neurologique avec apparition d'une HTIC réfractaire au traitement médical maximal. La fistule carotido-caverneuse est une complication rare mais grave pouvant engager le pronostic fonctionnel (cécité) et vital (hémorragie méningée et intracérébrale).L'artériographie et l'embolisation en un seul temps ont considérablement amélioré le pronostic.
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Nibrass C, Ahmed C, Lina J, Mejda B, Leila EM. [Exophthalmos revealing a carotid-cavernous fistula: about 2 cases]. LA TUNISIE MEDICALE 2014; 92:512-513. [PMID: 25775298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Bilbin-Bukowska A, Stepień A, Brzozowski K, Piasecki P, Skrobowska E. [Diagnostic and therapeutic problems of bilateral carotid-cavernous sinus fistula]. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2014; 36:345-347. [PMID: 24964514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Carotid-cavernous sinus fistula is an abnormal connection between the internal carotid artery, external one or their meningeal branches and the sinus cavernous. It can be the spontaneous or post-traumatic pathology. The main clinical syndrome is Dandy's triad: pulsating exophthalmia, chemosis, bruit in the region of orbit. These syndromes appear in the case of the most frequent direct carotid-cavernous sinus fistula (type-A in Barrow classification). Indirect carotid-cavernous sinus fistulas are significantly more uncommon and the symptoms can be atypical and less intensive. It makes difficulties in establishing the right diagnosis. The case report concerns the occurrence of bilateral carotid-cavernous sinus fistula, supplying by numerous arteries, with atypical clinical picture.
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Tan ACS, Farooqui S, Li X, Tan YL, Cullen J, Lim W, Leng SL, Looi A, Tow S. Ocular manifestations and the clinical course of carotid cavernous sinus fistulas in Asian patients. Orbit 2014; 33:45-51. [PMID: 24195725 DOI: 10.3109/01676830.2013.851253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To study the clinical course with regard to both the angiographic and visual outcomes of carotid cavernous fistulas (CCFs). BACKGROUND Carotid cavernous sinus fistulas (CCFs) are conditions which often present with ocular signs and symptoms. The clinical presentation of CCFs is varied according to the anatomy, haemodynamics and size of the CCF. CCFs causing significant symptoms or vision loss should be treated with embolization. METHODS This is a retrospective review of the medical records of all CCF cases seen in the Singapore National Eye Centre from September 2002 to December 2011. RESULTS 45 patients who had confirmed CCF on conventional cerebral angiography were included. Anterior draining CCFs presented with orbital congestion while posterior draining CCFs presented with pain, diplopia and cranial nerve palsies. Mild residual symptoms were still present in 85% of treated direct CCFs despite complete angiographic closure however 52% of treated dural CCFs had complete resolution of symptoms despite only half of those achieving angiographic closure. Treated and untreated dural CCFs had similar outcomes (87% versus 76% recovered or improved (p > 0.05)). Poor outcomes can result from residual diplopia or vision loss from complications of the CCF itself (e.g. compressive optic neuropathy, glaucoma, retinopathy) or complications from CCF embolization treatment (e.g. central retinal artery occlusion). CONCLUSION Presenting symptoms and signs are related to the angiographic drainage of CCFs. Angiographic outcomes after embolization treatment may not always correlate with clinical outcomes.
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Yamamoto M, Oishi H, Arai H. [Endovascular treatment for traumatic carotid-cavernous fistula]. NO SHINKEI GEKA. NEUROLOGICAL SURGERY 2013; 41:1105-1110. [PMID: 24317888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Aryasit O, Preechawai P, Aui-Aree N. Clinical presentation, aetiology and prognosis of orbital apex syndrome. Orbit 2013; 32:91-94. [PMID: 23514029 DOI: 10.3109/01676830.2013.764439] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To present the clinical features, determine the causes and evaluate the prognosis of orbital apex syndrome in patients of Songklanagarind Hospital. METHODS A retrospective review was conducted of patients diagnosed with orbital apex syndrome between January 1, 2002 and December 31, 2008. RESULTS In our series, the major cause of orbital apex syndrome was carotid-cavernous sinus fistula, for which 30 patients were diagnosed. After excluding those patients whose condition was caused by carotid-cavernous sinus fistula, 50 patients (58 eyes) were analyzed. The mean age of the patients was 47.60 ± 18.88 years (27 male patients and 23 female patients). The most common presenting symptom was blurred vision (86%). The median duration of the presenting symptom was 37.5 d. Of the 50 patients the most frequent aetiology of orbital apex syndrome was neoplasia (48%), of which lymphoma was the most common in this group. After treatment, the vision of 19.4% of the patients improved and proptosis improved by 68.4%. CONCLUSIONS The most common presenting symptom of orbital apex syndrome was blurred vision. The most frequent aetiology of orbital apex syndrome of all patients was carotid-cavernous sinus fistula, while the next most frequent was neoplasm, of which lymphoma was the most common in this group. Patients had a good outlook, after treatment directed at the cause, with a modest improvement in vision and exophthalmos in more than half of patients.
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Kim JW, Kim SJ, Kim MR. Traumatic carotid-cavernous sinus fistula accompanying abducens nerve (VI) palsy in blowout fractures: missed diagnosis of ‘white-eyed shunt’. Int J Oral Maxillofac Surg 2013; 42:470-3. [PMID: 23415244 DOI: 10.1016/j.ijom.2013.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 12/14/2012] [Accepted: 01/14/2013] [Indexed: 11/16/2022]
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Ikeda G, Kato N, Watanabe D, Ogata A, Kasuya H, Yamazaki T, Sugita K, Sonobe M. [A case of non-traumatic direct carotid-cavernous fistula presenting with cerebral infarction]. NO SHINKEI GEKA. NEUROLOGICAL SURGERY 2012; 40:785-792. [PMID: 22915700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 76-year-old female presented with a rare case of cerebral infarction as a complication of non-traumatic direct carotid-cavernous fistula (CCF). She had left hemiparesis and magnetic resonance imaging revealed cerebral infarction in the right watershed area. Angiography showed a right high-flow direct CCF with total blood steal. Preoperative 123I-IMP SPECT revealed a hypoperfusion area in the region of the right anterior cerebral artery and right middle cerebral artery. In addition, she had double vision caused by abducens nerve palsy. Transarterial embolization of the fistula with endovascular trapping using detachable coils achieved complete obliteration of the right internal carotid artery and adequate flow reduction of the direct CCF. Postoperative angiography showed good filling of the collateral-flow via the posterior communicating artery without retrograde blood steal to the CCF. Her symptoms improved gradually after the procedure. Diffusion-weighted MR imaging obtained 8 days after the procedure revealed a few high signals in the right hemisphere, suggesting cerebral infarctions, but she presented no symptom. Postoperative 123 I-IMP SPECT showed an improvement of cerebral perfusion in the region of the right MCA posterior and left MCA. Cerebral ischemia caused by direct CCF is rare, and there are only a few reports of non-traumatic direct CCF presenting with cerebral infarction. This very rare case suggests that endovascular trapping is safe and useful as a treatment for direct CCF, especially in the case of an elderly patient with total blood steal.
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Barut BO, Tascilar N, Aciman E, Acikgoz M, Ekem S. Carotid cavernous fistula with bilateral thalamic infarct. J PAK MED ASSOC 2012; 62:726-728. [PMID: 23866525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Carotid cavernous fistula (CCF) is an abnormal communication between cavernous sinus and carotid arterial system. Diagnosis depends on clinical manifestations and MRI findings and angiography. Clinical presentation of CCFs is characterized with chemosis, orbital bruit and pulsatile proptosis. Cranial nerve dysfunction and orbital pain might accompany these symptoms. Although spontaneous remission might occur, sometimes CCF might develop life threatening complications. Here in this case we presented a patient with CCF who afterwards developed bilateral thalamic infarct. Cerebral ischemia in CCF is a rare complication and CCF together with bilateral thalamic infarct has not been reported before.
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Pang PF, Jiang ZB, Zhou B, Li ZR, Huang MS, Zhu KS, Guan SH, Chen JW, Shan H. [Diagnosis and treatment of carotid-cavernous fistula: analysis of 28 patients]. ZHONGHUA YI XUE ZA ZHI 2012; 92:1458-1462. [PMID: 22944030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of endovascular treatment for different types of carotid cavernous fistula (CCF) via the approach of internal carotid artery (ICA) or inferior petrosal sinus (IPS). METHODS From April 2005 to June 2010, 28 CCF patients underwent endovascular treatment at our institution. There were 13 males and 15 females with a mean age of 39 years (range: 21 - 71). According to the Barrow's classification, they were classified into type A (n = 21), type B (n = 2) and type D (n = 5). Patients of type A underwent detachable balloon embolization of ipsilateral cavernous sinus or stent-graft placement via the ICA approach. Patients of types B and D received detachable coil plus n-BCA (n-butyl-2-cyanoacrylate) embolization of ipsilateral cavernous sinus via the IPS approach. The technical results, complications and therapeutic outcomes were reviewed. RESULTS Detachable balloons (number: 1 - 4) were used in 16 patients of type A. Angiography at immediate postembolization showed a complete occlusion of fistula in 15 patients and a small residual fistula (< 20%) in 1 patient. Five patients of type A received stent-graft placement. One stent was placed in 4 patients and 2 stents in 1 patient. Complete fistula closures with preserved ICA were documented on immediate angiogram in 3 patients whereas a large residual flow (> 50%) persisted in 1. The fistula was completely occluded after 3 detachable balloons were deployed in affected cavernous sinus through a gap between stent and vascular wall. Both fistula and ICA were occluded in 1 patient after stenting. No cerebral infarction was observed due to the adequate collateral blood flow from contralateral ICA. Complete closures of affected cavernous sinus were achieved in 6 patients of types B and D while residual flow (< 50%) persisted in 1. The number of detachable coils for each embolization ranged from 3 to 8 (mean: 6.0). The volume of n-BCA mixture varied from 1.0 to 2.1 ml (mean: 1.3). The mean duration of n-BCA injection was 65 s (range: 45 - 90). Clinical symptoms were completely relieved in 26 patients. During the mean follow-up period of 30 months (range: 12 - 60), no recurrence of clinical symptoms was observed. No thrombosis or stenosis was found in the lumina of stents. CONCLUSION Detachable balloon embolization is the preferential treatment for direct CCF. Detachable coil plus n-BCA embolization of cavernous sinus via the IPS approach is an efficient and safe treatment for indirect CCF.
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Takai Y, Tanito M, Miyazaki T, Sugimoto K, Akiyama Y, Ohira A. Ocular pulse amplitude measured by PASCAL dynamic contour tonometry in patients with a cavernous sinus dural arteriovenous fistula. Acta Ophthalmol 2012; 90:e333-5. [PMID: 21951977 DOI: 10.1111/j.1755-3768.2011.02263.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Masaya-Anon P. Isolated oculomotor nerve palsy in a white-eyed patient with dural carotid-cavernous sinus fistulas: a case report. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 2012; 95 Suppl 4:S143-S146. [PMID: 22696867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The study reported a woman with dural carotid-cavernous sinus fistulas (CCFs) who presented with a unilateral white-eyed appearance, and painful oculomotor nerve palsy with pupillary involvement. After cerebral angiography, which revealed posterior drainage of the fistulas, the dural CCFs closed, the oculomotor nerve palsy subsided spontaneously and no recurrence occurred throughout the 2-year follow-up. Dural CCFs should be kept in mind when patients present with painful oculomotor nerve palsy. Moreover, cerebral angiography remains the standard diagnostic method and fistulas may close spontaneously following this procedure.
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Santos-Franco JA, Lee A, Nava-Salgado G, Zenteno M, Gómez-Villegas T, Dávila-Romero JC. [Traumatic arteriovenous pial fistula masquerading as a carotid-cavernous fistula: an uncommon disorder with an unusual presentation]. GAC MED MEX 2012; 148:76-80. [PMID: 22367311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Traumatic intracranial pial arteriovenous fistulae are infrequent lesions. Their cardinal signs have been related to mass effect and hemorrhage, but their clinical manifestations due to venous retrograde flow into ophthalmic veins has never been described. This phenomenon is usually seen in dural arteriovenous fistula draining to the cavernous sinus or carotid-cavernous sinus fistula.A traumatic intracranial pial arteriovenous fistula arising from the supraclinoid internal carotid artery in a young patient was revealed by aggressive behavior and ophthalmologic manifestations. The endovascular management included the use of coils, stent, and ethylene-vinyl alcohol with transient balloon occlusion of the parent vessel.
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Hatabe N, Chikama T, Sonod KH, Ishihara H, Suzuki M. [A case of anterior condylar confluence dural arteriovenous fistula with initial onset of ocular symptoms]. NIPPON GANKA GAKKAI ZASSHI 2011; 115:905-909. [PMID: 22117323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To report a case of anterior condylar confluence dural arteriovenous fistula (ACC dAVF) with initial onset of ocular symptoms. CASE A 63-year-old man with conjunctival injection and eyelid edema with a suspected carotid cavernous fistula (CCF) was referred to our department by the department of neurosurgery of our hospital. On his first visit, his left eye showed marked conjunctival injection and eyelid edema OS. Those findings were consistent with CCF, however, three-dimensional angiography indicated a diagnosis of ACC dAVF. His ocular symptoms improved immediately following transvenous embolization with coils at the shunting point. CONCLUSION Although most cases of ACC dAVF start with tinnitus, this case showed ocular abnormalities without tinnitus as the initial symptoms.
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Chan HW, Haliasos N, Derakhshani S, Vindlacheruvu R, Chawda S. Delayed caroticocavernous fistula after stent-assisted coil embolization of intracavernous carotid aneurysm: should we manage conservatively? Acta Neurochir (Wien) 2011; 153:1291-5. [PMID: 21347579 DOI: 10.1007/s00701-011-0968-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 02/07/2011] [Indexed: 11/24/2022]
Abstract
Constructive endovascular techniques remain the mainstay for the treatment of cavernous carotid aneurysms due to their efficacy. However, they do harbor risks of complications, such as thromboembolic events, arterial injuries, and vessel occlusions. A 58-year-old lady presented with delayed caroticocavernous fistula (CCF) 1 month after stent-assisted coil embolization of a cavernous carotid aneurysm (CCA). Following this, her caroticocavernous fistula resolved spontaneously with no further intervention. Our case demonstrates a unique presentation of a CCF as a delayed complication of stent-assisted coil embolization of CCA and the spontaneous resolution of the CCF. Symptomatic CCFs are commonly treated as an emergency in many institutions and the question arises as to whether we should adopt a conservative policy in the light of this case report.
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Aldea S, Guedin P, Roccatagliata L, Boulin A, Auliac S, Dupuy M, Cerf C, Gaillard S, Rodesch G. Controlateral cavernous syndrome, brainstem congestion and posterior fossa venous thrombosis with cerebellar hematoma related to a ruptured intracavernous carotid artery aneurysm. Acta Neurochir (Wien) 2011; 153:1297-302. [PMID: 21380852 DOI: 10.1007/s00701-011-0982-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 02/17/2011] [Indexed: 11/25/2022]
Abstract
Intracavernous carotid artery aneurysms (ICCAs) are rarely associated with life-threatening complications. We describe a 55-year-old woman who, after the rupture of an intracavernous carotid artery aneurysm, presented with a contralateral cavernous sinus syndrome and severe posterior fossa and spinal cord symptoms. Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a "locked-in" state. The patient fully recovered with anticoagulation therapy. Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications related to venous thrombosis.
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Abstract
Here we report a 79-year-old woman who presented with a 7-day history of headache, nausea, vomiting, and was found to have proptosis and ptosis. Laboratory findings showed hyponatremia, hypocortisolism, secondary hypothyroidism and low follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. CT angiography (CTA) showed a vascular lesion in sella causing a mass affect on the pituitary gland which proved to be a carotid cavernous fistula (CCF) by conventional angiography. The lesion was subsequently treated with coil placement and patient's hyponatremia was successfully treated with corticosteroid and thyroid hormone replacement. Though rare, CCF should be considered in the differential diagnosis of sellar lesions. Also, in patients with CCF hyponatremia, hypotension or signs of hypothyroidism should warrant a work-up for pituitary function.
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Fernández N, Murias E, Vega P, Sainz A, Meilán A. [Angioplasty confirmation of the spontaneous resolution of two low-flow carotid-cavernous fistulas]. Neurologia 2010; 25:333-336. [PMID: 20643045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Zemba M, Enache V, Manole C, Cucu B, Furedi G, Halmaci V. [The secret of red eyes]. OFTALMOLOGIA (BUCHAREST, ROMANIA : 1990) 2010; 54:78-83. [PMID: 21137195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
"Red eye" is a sign and the same time a symptom frequently met in the ophthalmological practice. The "red eye" is not always the clinical manifestation of a common conjunctivitis. We will present a case report of a patient who accused conjunctival hyperemia, lacrimation, foreign--body sensation; she was also describing recurrent conjunctivitis for the past year. After an detailed ophthalmologic examination and interdisciplinary consultations. She was diagnosed with Basedow Disease and paraselar meningioma with invasion in the pterigoid fossa. The authors are suggesting that there is an indirect left carotid - cavernous fistula.
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Pons Y, Ukkola-Pons E, Hunkemöller I, Raynal M, Lepage P, Blondet E, Rigal-Sastourne JC, Héran F, Kossowski M. [Post-traumatic carotid cavernous fistula: report of two cases]. REVUE DE LARYNGOLOGIE - OTOLOGIE - RHINOLOGIE 2010; 131:225-228. [PMID: 21491776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The authors reported the clinical presentation and therapeutic procedure of two cases. The physician has to be aware of this diagnosis when a patient is referred for a posttraumatic exophthalmia. The medical behaviour is multidisciplinary (ENT, ophthalmologist, radiologist and neurosurgeon). The imaging of choice is the angiography but angio-MRI and angio-CT can help to confirm the diagnosis. The endovascular embolization is the treatment of choice. It presents an acceptable risk of complication and a low risk of failure. In this paper the authors report 2 posttraumatic CCF cases treated with success by endovascular embolization.
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Yue J, Kong W, Yang C, Zhang S, Wang Y, Chen X. [The diagnosis and treatment of traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus (a report of 6 cases)]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2009; 23:843-845. [PMID: 20120865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE In order to prevent misdiagnosis and degrade death rate, we explored the early diagnosis and correct treatment methods of traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus. METHOD The clinic data of 6 cases who had traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus and were admitted in our hospital were analyzed retrospectively. Large numbers of literature about the disease were reviewed. Some early diagnosis methods and optimal treatment schemes were proposed. RESULT All patients had a history of cranium trauma and recurrent attacks nasal hemorrhage. There are two patients with a complication of sight loss in single eye. In the six cases, one case was treated with unilateral common carotid artery ligation, three cases were treated with aneurysm and internal carotid artery embolism by using sacculus proprius which is able to shedding, one case was treated with internal carotid artery embolism by using tiny circlip ring. These five patients were cured with no severe complication. One patient death of hemorrhage. His nasal cavity was tamponade repeatedly because repeat nasal hemorrhage. However, he had never treated with internal carotid artery embolism. CONCLUSION The patients who have traumatic pseudoaneurysm of internal carotid artery usually die of unmanageable hemorrhage. The patients may be cured if they could obtain an early diagnosis and correct treatment.
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Park YS, Jung JY, Ahn JY, Kim DJ, Kim SH. Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery. ACTA ACUST UNITED AC 2009; 72:741-6. [PMID: 19604552 DOI: 10.1016/j.surneu.2009.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 05/04/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery. CASE DESCRIPTION We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day. CONCLUSIONS Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary.
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