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Lindgren A, Ahmed SU, Bodani V, Chung E, Agid R, Barazarte HA, Nicholson PJ, Schaafsma JD, Radovanovic I, Terbrugge K, Mosimann PR, Krings T, Hendriks EJ. Embolization techniques of spontaneous direct carotid-cavernous fistulae: a single-center experience. Neuroradiology 2024:10.1007/s00234-024-03389-w. [PMID: 38869517 DOI: 10.1007/s00234-024-03389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Spontaneous direct carotid-cavernous fistula (CCF) are usually caused by a ruptured carotid cavernous aneurysm. We studied treatment of spontaneous direct CCFs in a single-center cohort of a high-volume tertiary referral center, reporting anatomical details, technical approaches of treatment, and outcomes. METHODS Adult patients with a spontaneous direct CCF treated between 2010-2022 with follow-up MRI and/or DSA imaging available were retrospectively analyzed. We studied age, sex, clinical presentation, angiographic findings, treatment techniques, outcomes, and complications. RESULTS Out of 80 patients with CCFs, twelve patients were treated for a non-traumatic direct CCF (15%) in 13 sessions. Median age was 65 years. Two patients had an underlying connective tissue disorder. In 10 cases, the direct CCF was caused by a ruptured cavernous carotid aneurysm. The direct CCFs were treated by endovascular transarterial embolization (10 cases), transvenous embolization (1 case), or surgery (1 case). Selective closure of the shunt was possible in 10 patients. Two patients were treated with parent vessel occlusion (PVO; one endovascular; one surgical, with bypass). Complications occurred in 2 / 12 patients (17%), with permanent morbidity in two patients (17%): trigeminal neuralgia after PVO and new infarct after surgical PVO and bypass. Selective closure of CCF resulted in no morbidity. There was no mortality in our series. CONCLUSION Spontaneous direct CCFs are caused by rupture of a cavernous carotid aneurysm in most cases. Selective closure of the shunt, usually feasible transarterially with coils, achieves good results. Reconstructive endovascular techniques are preferred to minimize treatment related neurological complications.
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Affiliation(s)
- Antti Lindgren
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Syed Uzair Ahmed
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Vivek Bodani
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Emily Chung
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Ronit Agid
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Hugo Andrade Barazarte
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Patrick Joseph Nicholson
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| | | | - Ivan Radovanovic
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Karel Terbrugge
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Pascal Roger Mosimann
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Eef J Hendriks
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Mehta TI, Arun A, Heiberger C, Cognetti D, Ray TR, Amans MR, Fargen K, Huisman TAGM, Hui F. Venous Pathologies and Interventions of the Head. Semin Neurol 2023; 43:439-453. [PMID: 37562454 DOI: 10.1055/s-0043-1771512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Intracranial venous pathologies are a historically underrecognized group of disorders that can have a devastating impact on patients. Despite advancements in peripheral venous disorders and arterial neurointerventions, intracranial venous pathologies have received comparatively little attention. Understanding the anatomy, physiology, clinical relevance, and treatment options of intracranial venous pathologies is fundamental to evolving therapies and research priorities. This article provides an overview of major intracranial venous pathologies, the respective pathophysiologies, and treatment options.
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Affiliation(s)
- Tej Ishaan Mehta
- The United States Air Force Medical Corps, Falls Church, Virginia
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Anirudh Arun
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Caleb Heiberger
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - David Cognetti
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tyler R Ray
- Department of Mechanical Engineering, University of Hawai'i at Mānoa, Honolulu, Hawaii
- Department of Cellular and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Matthew R Amans
- Department of Radiology, University of California San Francisco, San Francisco, California
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Kyle Fargen
- Department of Neurosurgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Thierry A G M Huisman
- Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Ferdinand Hui
- Department of Radiology, The Queen's Medical Center, Honolulu, Hawaii
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Takahashi CE, Virmani D, Chung DY, Ong C, Cervantes-Arslanian AM. Blunt and Penetrating Severe Traumatic Brain Injury. Neurol Clin 2021; 39:443-469. [PMID: 33896528 DOI: 10.1016/j.ncl.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Severe traumatic brain injury is a common problem. Current practices focus on the importance of early resuscitation, transfer to high-volume centers, and provider expertise across multiple specialties. In the emergency department, patients should receive urgent intracranial imaging and consideration for tranexamic acid. Close observation in the intensive care unit environment helps identify problems, such as seizure, intracranial pressure crisis, and injury progression. In addition to traditional neurologic examination, patients benefit from use of intracranial monitors. Monitors gather physiologic data on intracranial and cerebral perfusion pressures to help guide therapy. Brain tissue oxygenation monitoring and cerebromicrodialysis show promise in studies.
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Affiliation(s)
- Courtney E Takahashi
- Department of Neurology, Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA.
| | - Deepti Virmani
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
| | - David Y Chung
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA; Division of Neurocritical Care, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Neurovascular Research Unit, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Charlene Ong
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
| | - Anna M Cervantes-Arslanian
- Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
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Wang X, Zhang X, Gan L, Wang Y, Ma J, Zhong Y. Observation of fundus and optical coherence tomography angiography manifestations in carotid cavernous fistula patients. Graefes Arch Clin Exp Ophthalmol 2021; 259:2573-2582. [PMID: 33660092 DOI: 10.1007/s00417-021-05117-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aimed to investigate fundus and optical coherence tomography angiography (angio-OCT) manifestations in carotid cavernous fistula (CCF) patients. METHODS Nine eyes of 7 CCF patients diagnosed with digital subtraction angiography (DSA) were included in this study. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp, fundus, spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (angio-OCT) examination in the CCF patients and 10 normal controls were conducted. Subfoveal choroidal thickness (SFCT) and macular vascular density (VD) were measured and compared with the control group. SFCT and VD were also compared before and after embolization therapy. RESULTS Two male and 5 female CCF patients were included. The average age was 59.7 ±10.0 (years). Embolization therapy was conducted in 3 patients. Fundus manifestations included disc oedema and exudation, retinal venular dilation, and retinal haemorrhage. B-scan OCT examination revealed retinal and choroidal undulations, retinal-choroidal thickness, retinal cystoid oedema, and subretinal fluid. The SFCT of the affected eyes was thicker than that of the control group (412.3 ± 123.7 μm vs. 272.9 ± 62.9 μm; P = 0.006). Macular superficial capillary plexus (SCP) VD in affected eyes was lower than that in the control eyes (50.1 ±2.3 % vs. 52.7 ± 1.7 % ; P = 0.014). The SFCT was reduced, and the vessel density in the SCP was increased after embolization therapy. CONCLUSION We demonstrated decreased VD in CCF patients with specific fundus and OCT manifestations. The pathological changes were immediately reduced after embolization therapy. This preliminary observation provides a supplemental method for the diagnosis and pathophysiological examination of CCF patients.
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Affiliation(s)
- Xuqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Xiaobo Zhang
- Department of Interventional Adiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Linyang Gan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Yuhan Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongdan, Beijing, 100730, China.
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongdan, Beijing, 100730, China.
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Visual impairment in high flow and low flow carotid cavernous fistula. Sci Rep 2019; 9:12872. [PMID: 31492949 PMCID: PMC6731213 DOI: 10.1038/s41598-019-49342-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 08/22/2019] [Indexed: 11/08/2022] Open
Abstract
Our aim is to study the varied posterior segment manifestations, level of visual impairment (VI) and its causes in carotid cavernous fistula (CCF) patients. A retrospective study was done, wherein data was obtained from 48 digital subtraction angiogram (DSA) proven CCF patients. CCF was classified according to Barrow et al., based on DSA into type A (high flow) and types B, C and D (low flow). High flow CCF was present in 8 (16.7%) and low flow CCF was present in 42 (83.3%). Compared to low flow group, patients in high flow group were younger and had a history of trauma (p < 0.05). Posterior segment findings ranged from familiar stasis retinopathy and optic neuropathy (both, glaucomatous and ischemic) to uncommon findings of central retinal artery occlusion, Terson syndrome and combined retinal and choroidal detachment. Retinal vein dilatation was the most common finding in both groups. The high flow CCF group had 6 (75%) patients that had VI. This was acute in 4 (50%) patients and delayed in 2 (25%). In the low flow group 10 (23.8%) of patients had delayed VI. The identification of "3 point sign" is a novel finding of this study, not described before. While none of three findings (disc hyperaemia, retinal vein dilatation and intra-retinal haemorrhage) in isolation were predictive of visual loss, but when present together results in visual loss. Posterior segment changes were varied, some are uncommon and can occur in various combinations. "3 point sign" must be identified at the earliest to prevent visual impairment. The incidence of VI in CCF patients is high.
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Holland LJ, Mitchell Ranzcr K, Harrison JD, Brauchli D, Wong Y, Sullivan TJ. Endovascular treatment of carotid-cavernous sinus fistulas: ophthalmic and visual outcomes. Orbit 2018; 38:290-299. [PMID: 30465621 DOI: 10.1080/01676830.2018.1544261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: The main objective was to report the epidemiology, clinical manifestations, angiography features, treatment modality and post-treatment outcomes in patients diagnosed with carotid cavernous fistulas (CCF). Methods: A retrospective review of the medical imaging database in conjunction with medical records from 2004 to 2017 at the Royal Brisbane and Women's Hospital (RBWH) was conducted.We identified 39 patients with CCF (16 direct, 23 indirect). A total of 37 diagnoses were confirmed by direct catheter angiography. The remaining two cases were diagnosed using magnetic resonance imaging/magnetic resonance angiography. Results: Coils were deployed in 100% of direct and 83% of treated indirect fistulas that were treated. Other embolic agents were deployed alone or in combination with coils. Successful angiographic closure was achieved in 93% of direct and 92% of indirect fistulas. Multiple treatments were required in 33% of direct and 16% of indirect fistulas. Visual acuity improved in patients with direct fistulae(p = 0.02) and was preserved in those with indirect fistulae. Post-treatment diplopia persisted in six patients with direct fistulas and three patients with indirect fistulas. Four patients with indirect fistulas experienced persistent ocular hypertension post-treatment compared to two patients with direct fistulas. Conclusions: Endovascular coils are the most commonly deployed treatment for CCF. Both indirect and direct fistulas achieved high rates of closure; however, indirect fistulas were less likely to require multiple treatments. Good post-procedural vision was achieved for both groups.
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Affiliation(s)
- Lee J Holland
- a Department of Ophthalmology, Royal Brisbane and Women's Hospital , Herston , Queensland , Australia
| | - Ken Mitchell Ranzcr
- b Department of Medical Imaging, Royal Brisbane and Women's Hospital , Queensland , Australia
| | - John D Harrison
- a Department of Ophthalmology, Royal Brisbane and Women's Hospital , Herston , Queensland , Australia
| | - Damien Brauchli
- b Department of Medical Imaging, Royal Brisbane and Women's Hospital , Queensland , Australia
| | - Yun Wong
- c Department of Ophthalmology, James Cook University Hospital , Middlesbrough , UK
| | - Timothy J Sullivan
- a Department of Ophthalmology, Royal Brisbane and Women's Hospital , Herston , Queensland , Australia.,d Department of Ophthalmology, University of Queensland , St Lucia , Queensland , Australia
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Henderson AD, Miller NR. Carotid-cavernous fistula: current concepts in aetiology, investigation, and management. Eye (Lond) 2018; 32:164-172. [PMID: 29099499 PMCID: PMC5811734 DOI: 10.1038/eye.2017.240] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/09/2022] Open
Abstract
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. Direct CCFs are characterized by a direct connection between the internal carotid artery (ICA) and the cavernous sinus, whereas dural CCFs result from an indirect connection involving cavernous arterial branches and the cavernous sinus. Direct CCFs frequently are traumatic in origin and also may be caused by rupture of an ICA aneurysm within the cavernous sinus, Ehlers-Danlos syndrome type IV, or iatrogenic intervention. Causes of dural CCFs include hypertension, fibromuscular dysplasia, Ehlers-Danlos type IV, and dissection of the ICA. Evaluation of a suspected CCF often involves non-invasive imaging techniques, including standard tonometry, pneumotonometry, ultrasound, computed tomographic scanning and angiography, and/or magnetic resonance imaging and angiography, but the gold standard for classification and diagnosis remains digital subtraction angiography. When a direct CCF is confirmed, first-line treatment is endovascular intervention, which may be accomplished using detachable balloons, coils, liquid embolic agents, or a combination of these tools. As dural CCFs often resolve spontaneously, low-risk cases may be managed conservatively. When invasive treatment is warranted, endovascular intervention or stereotactic radiosurgery may be performed. Modern endovascular techniques offer the ability to successfully treat CCFs with a low morbidity and virtually no mortality.
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Affiliation(s)
- A D Henderson
- Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - N R Miller
- Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
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New and Emerging Interventional Neuroradiologic Techniques for Neuro-Opthalmologic Disorders. J Neuroophthalmol 2013; 33:282-95. [DOI: 10.1097/wno.0b013e3182a319e7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Ophthalmologic outcome of direct and indirect carotid cavernous fistulas. Int Ophthalmol 2012; 32:153-9. [DOI: 10.1007/s10792-012-9550-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/02/2012] [Indexed: 11/27/2022]
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Miller NR. Dural Carotid-Cavernous Fistulas: Epidemiology, Clinical Presentation, and Management. Neurosurg Clin N Am 2012; 23:179-92. [DOI: 10.1016/j.nec.2011.09.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND A carotid cavernous fistula (CCF) develops spontaneously or after trauma, and older publications suggest that the majority of CCF cases are caused by trauma. However, more recent reports question the prevalence of CCFs caused by trauma. METHODS The clinical records of 37 consecutive patients diagnosed with a CCF were reviewed. The disease etiology, patient demographics, anatomical classification, and clinical course were investigated. RESULTS The CCF was spontaneous in 30 patients, and was related to head or neck trauma in seven patients. The mean age of all patients was 65.8 +/- 10.5 years, and 30 (81.1%) were women. Eight had diabetes and 14 had hypertension. The major signs and symptoms were congestion (86.4%), diplopia (81.1%), bruit (59.5%), and headaches/orbital pain (62.2%). Exophthalmos (67.6%) and elevated intraocular pressure (40.5%) were also frequently noted. In the Barrow classification, seven patients were classified as type A, four as type B, three as type C, and 20 as type D. The classification could not be established in three patients who did not undergo angiography. Of note, almost all patients had consulted an ophthalmologist before the diagnosis. CONCLUSION Spontaneous/low-flow CCF is more prevalent than previously reported. The role of ophthalmologists is important because the majority of patients initially consult ophthalmologists, and the signs of low-flow CCF are subtle and may be overlooked.
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Oishi A, Miyamoto K, Yoshimura N. Etiology of carotid cavernous fistula in Japanese. Jpn J Ophthalmol 2009; 53:40-43. [DOI: 10.1007/s10384-008-0611-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
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Cerebrovascular trauma. Eur Radiol 2008; 18:1531-45. [PMID: 18392832 DOI: 10.1007/s00330-008-0915-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 12/24/2007] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
Abstract
Vascular injury of the head and neck region is a rare and often life-threatening complication of head or neck trauma and is due to two major pathomechanisms: penetrating or blunt trauma. Both the arterial and the venous site of the CNS vasculature can be involved, the latter one being often overlooked. Concerning arterial lesions, depending on how many layers of the arterial vessel are affected and on the spatial relationship to adjacent structures, dissections, false aneurysms or arteriovenous fistulae may develop. On the venous side, dural tears, compressive effects on pial veins and a deranged clotting system may lead to delayed venous thrombosis. In this review we describe clinical and imaging findings, as well as diagnostic and treatment strategies in these lesions.
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Tatewaki Y, Nishimura S, Ezura M, Nishino A, Sasaki K, Utsunomiya A, Suzuki S, Uenohara H, Sakurai Y. Endovascular GDC Treatment of an Idiopathic Carotid-Cavernous Fistula Caused by Aneurysmal Rupture of the Intra-Cavernous Carotid Artery. Case Report. Interv Neuroradiol 2006; 12:174-7. [PMID: 20569626 DOI: 10.1177/15910199060120s130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 12/15/2005] [Indexed: 11/15/2022] Open
Abstract
SUMMARY Aneurysmal rupture of the intra-cavernous carotid artery may cause idiopathic carotid-cavernous fistula (CCF), and the treatment choice for occluding shunting fistula in this type of CCF is an endovascular approach using detachable balloons. However, little has been reported on treating such lesions with the intra-aneurysmal embolization using Guglielmi detachable coils (GDCs).To our knowledge, ours is the first reported case of successful treatment by selective intra-fistula and intra-aneurysmal embolization with GDCs. A 74-year-old woman exhibited proptosis and chemosis of her left eye over a period of one month. Symptoms of double vision in conversion and pulsatile murmur in her left eye were also noted. Angiography revealed an intra-cavernous aneurysm of the left internal carotid artery (ICA) with a shunting fistula, which drained into the dilated cavernous sinus, superior orbital vein (SOV), superior petrosal sinus, inferior petrosal sinus, and pterygoid plexus.We thought the fistula would occlude by intra-aneurysmal embolization, but we had no confidence of tight packing of the aneurysm since the aneurismal neck was relatively wide. So, we embolized the venous side of the shunting fistula and then the dome of the aneurysm with GDCs. Immediately after the operation, her symptoms and signs were ameliorated, and complete occlusion of the CCF was observed on long-term follow-up. We suggest selective intrafistula and intra-aneurysmal embolization with GDCs as an alternative method of treatment of idiopathic CCF originating from aneurysmal rupture of the intra-cavernous carotid artery.
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Affiliation(s)
- Y Tatewaki
- National Hospital Organization, Sendai Medical Center, Stroke Center in Department of Neurosurgery; Japan
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Ringer AJ, Salud L, Tomsick TA. Carotid cavernous fistulas: anatomy, classification, and treatment. Neurosurg Clin N Am 2005; 16:279-95, viii. [PMID: 15694161 DOI: 10.1016/j.nec.2004.08.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Andrew J Ringer
- Department of Neurosurgery, The Neuroscience Institute, Mayfield Clinic, University of Cincinnati College of Medicine, ML 0515, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
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Raicević R, Jovicić A, Marković L, Djordjević D, Aleksić P, Perić P, Kostić J. [Role of endovascular procedures in the treatment of cerebral ischemia]. VOJNOSANIT PREGL 2002; 59:75-80. [PMID: 11928194 DOI: 10.2298/vsp0201075r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
<zakljucak> Ishemijska bolest mozga predstavlja klinicki entitet sa vjerovatno najslozenijom etiopatogenezom u humanoj medicini. Slozenost i beskrajna isprepletenost patofizioloskih procesa diktiraju i planiranje terapijskog programa koji, po logici ovakvog slijeda patofizioloskih dogadjaja, mora biti multitopan, odnosno viseznacan. U skladu sa prodorima u poznavanju etiologije, patogeneze i patofiziologije IBM poslednjih godina smo svjedoci znacajnih prodora u dijagnostici kljucnih poremecaja odgovornih za nastanak IBM, ali i patoloskih dogadjaja koji prate razvoj same bolesti i predstavljaju markere povecanog rizika ponavljanih epizoda ishemije mozdanog parenhima. U tom smislu endovaskularne tehnike, sem znacajnih dijagnostickih informacija vezanih za ishemijsku bolest mozga, sa modalitetima kombinovanih terapijskih procedura (agensi protiv vazospazma, tromboliticka sredstva) postaju znacajan dio terapijskog programa ishemijske bolesti mozga u strogo definisanim i selekcionisanim grupama bolesnika.
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Phatouros CC, Meyers PM, Dowd CF, Halbach VV, Malek AM, Higashida RT. Carotid Artery Cavernous Fistulas. Neurosurg Clin N Am 2000. [DOI: 10.1016/s1042-3680(18)30147-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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FitzPatrick M, Tartaglino LM, Hollander MD, Zimmerman RA, Flanders AE. Imaging of sellar and parasellar pathology. Radiol Clin North Am 1999; 37:101-21, x. [PMID: 10026732 DOI: 10.1016/s0033-8389(05)70081-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article reviews the complex anatomic relationships between structures in the sellar and parasellar regions. Normal anatomy and the normal imaging spectrum are reviewed, with emphasis on the diversity of pathology that originates from this region. Both CT and MR imaging may be used to evaluate the sellar and parasellar regions. This article discusses how modern imaging techniques enable characterization of the many lesions that alter the structure and function of normal sellar and parasellar anatomy.
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Affiliation(s)
- M FitzPatrick
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Lemme-Plaghos L, Garbugino S, Villarrodona L, Ceciliano A. Supraclinoid carotid artery fistula mimicking a carotid-cavernous fistula. Neuroophthalmology 1999. [DOI: 10.1076/noph.21.1.47.3929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Spinnato S, Talacchi A, Perini S, Dolenc V, Bricolo A. Conservative treatment of a traumatic direct low-flow carotid-cavernous sinus fistula: a case report. Acta Neurochir (Wien) 1998; 139:1181-4. [PMID: 9479426 DOI: 10.1007/bf01410980] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A case of a 17-year-old boy presenting with a traumatic carotid-cavernous sinus fistula (CCSF), associated with an intracavernous pseudo-aneurysm, is reported. On angiography, the CCSF proved to be a direct and low-flow shunt. Conservative management was chosen and definitive closure of the fistula was obtained in two months by daily self-compression of the common carotid artery.
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Affiliation(s)
- S Spinnato
- Department of Neurological Sciences and Vision, University and Hospital, Verona, Italy
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Lucas CP, Zabramski JM, Spetzler RF, Jacobowitz R. Treatment for intracranial dural arteriovenous malformations: a meta-analysis from the English language literature. Neurosurgery 1997; 40:1119-30; discussion 1130-2. [PMID: 9179884 DOI: 10.1097/00006123-199706000-00002] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The treatment of intracranial dural arteriovenous malformations (DAVMs) remains problematic. Options include ligature of feeding vessels, endovascular procedures, surgical obliteration, or a combination of the latter two. We conducted a meta-analysis of the English language literature on DAVMs to determine the most effective treatment option related to location and angiographic characteristics. METHODS The criteria for inclusion were pre- and post-treatment angiography, a description of the type of treatment, and clinical outcome. The analysis included a total of 258 patients, 248 from a review of 223 published articles and 10 from the authors' series. DAVMs were divided into six categories by location, and the results of treatment were compared based on obliteration rates using chi 2 analysis. RESULTS In transverse-sigmoid sinus DAVMs (n = 64), combined therapy (endovascular plus surgical treatment) proved significantly more effective than either therapy alone (P < 0.01). For lesions of the tentorial incisura (n = 66), combined therapy and surgical obliteration alone proved superior to embolization (P < 0.001). For lesions of the cavernous sinus (n = 67), treatment was primarily endovascular, with success rates of 62 to 78% for transarterial and transvenous approaches, respectively. In the anterior fossa (n = 23), surgical obliteration was highly effective, with a success rate of 95%. The small number of cases in both the superior sagittal sinus (n = 28) and middle fossa (n = 10) regions, precluded any statistical analysis. Finally, simple ligature of feeding vessels produced success rates of only 0 to 8% and can no longer be recommended. CONCLUSION There is no single ideal treatment for the obliteration of DAVMs. The management of each case is best considered individually. The results of this review serve as a rational starting point for the selection of treatment options.
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Affiliation(s)
- C P Lucas
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Burton EA, Jamieson DG. Ketoprofen and carotico-cavernous fistula. Cephalalgia 1997; 17:40-1. [PMID: 9051335 DOI: 10.1046/j.1468-2982.1997.1701040.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Whilst treating a patient with traumatic direct carotico-cavernous fistula, pain relief was difficult to achieve. Adequate doses of ibuprofen and codeine were ineffective, but single doses of ketoprofen alleviated pain in a reproducible manner. Although similar in analgesic efficacy to codeine, and a potent inhibitor of cyclooxygenase like ibuprofen, ketoprofen has other actions which may account for the differential response seen. This observation may help elucidate the nature of local mediators involved in the pathogenesis of vascular headache pain.
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Affiliation(s)
- E A Burton
- University Department of Neurology, Queen Elizabeth Hospital, Birmingham, UK
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