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Bahar A, Pranata J, Gunawan A, Soraya GV. Clinical characteristics, angiographic findings and treatment outcomes of carotid cavernous fistula in Makassar, Indonesia: a single-centre experience. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Abstract
Background
Carotid cavernous fistula (CCF) is an abnormal arteriovenous shunt between the carotid artery or its branches, with the cavernous sinus. It is still common in developing countries, and is mostly due to traumatic origin. Endovascular treatment has emerged as the primary mode of treatment of CCF. This is the first study describing the clinical manifestation, angiographic characteristic, and the challenges we face in endovascular treatment of CCF cases in Makassar, Indonesia.
Results
This descriptive study was conducted between January 2019 to March 2022. We reviewed medical records and angiograms of all patients diagnosed with CCF at the Wahidin General Hospital, Makassar. Clinical manifestations, angiogram results, treatment, and outcome data were analyzed. A total of 23 patients were included in this study, with 17 (73.9%) direct CCF (Barrow type A) and 6 (26.1%) indirect CCF (Barrow type B, C, D). The mean age of patients were 32 years old. The three most common clinical manifestations were proptosis (n = 21, 91.3%), headache (n = 14, 60.8%), and chemosis (n = 14, 60.8%). The three most common drainage routes were via the superior ophthalmic vein (n = 23, 100%), inferior petrosal sinus (n = 12, 52.1%), and superficial middle cerebral vein (n = 6, 26.0%). All patients with direct CCF (n = 17) had endovascular treatment, resulting in 13 cases with complete occlusion (76.5%), 3 cases with incomplete occlusion (17.6%), and 1 (5.9%) procedure cancelled due to difficult navigation. Occlusion of fistula was best achieved with detachable coil, with a technical success rate of 90%. In indirect CCF (n = 6), 4 patients were treated conservatively and 2 with endovascular treatment, with complete occlusion in 2 patients.
Conclusions
Carotid cavernous fistula patients commonly presented with orbital symptoms, headache, or neuro-ophthalmologic signs. The most common drainage pattern is via anterior route. Posterior, superior and lateral drainage were not found in indirect CCF. Endovascular treatment is an effective method for fistula closure, especially in the case of direct fistula. Challenges in endovascular treatment are related to the anatomy of the fistula and cavernous sinus.
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Rahmatian A, Yaghoobpoor S, Tavasol A, Aghazadeh-Habashi K, Hasanabadi Z, Bidares M, Safari-kish B, Starke RM, Luther EM, Hajiesmaeili M, Sodeifian F, Fazel T, Dehghani M, Ramezan R, Zangi M, Deravi N, Goharani R, Fathi M. Clinical efficacy of endovascular treatment approach in patients with carotid cavernous fistula: A systematic review and meta-analysis. World Neurosurg X 2023; 19:100189. [DOI: 10.1016/j.wnsx.2023.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
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3
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Abaunza-Camacho JF, Vergara-Garcia D, Madrinan-Navia H, Riveros WM, Caballero A. Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical note. J Neurol Surg A Cent Eur Neurosurg 2022. [PMID: 35073584 DOI: 10.1055/s-0041-1741547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Indirect carotid–cavernous fistulas (iCCFs) are shunts between meningeal branches of the internal carotid and/or the external carotid arteries and the cavernous sinus. They account for 83% of all carotid–cavernous fistulas (CCFs). Symptomatic iCCFs and those with increased risk of hemorrhage should be treated. Transvenous endovascular treatment is the preferred treatment modality. However, in complex cases, a combination of transarterial and transvenous approaches (multimodal treatment) is required.
Methods A middle-aged woman presented with signs of increased intraocular pressure, blurry vision, diplopia, left proptosis, chemosis, conjunctival injection, ptosis, and cranial nerve VI palsy. Imaging confirmed the presence of a Barrow type D and Thomas type 4 iCCF with cortical venous reflux (CVR).
Results The patient underwent transarterial and transvenous onyx embolization of the shunt, achieving a complete obliteration of the fistula. No complications occurred and the patient had a satisfactory postprocedural evolution.
Conclusion Multimodal onyx embolization is an effective option for the treatment of a complex symptomatic iCCF. If CVR is identified, these lesions should be promptly treated to prevent hemorrhage secondary to rupture.
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Affiliation(s)
- Juan Felipe Abaunza-Camacho
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - David Vergara-Garcia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - Humberto Madrinan-Navia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - William Mauricio Riveros
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - Alberto Caballero
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
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George RS, Pollmann AS, Maxner CE. Delayed Onset of Mixed Cranial Neuropathies and Cluster Headache After Embolization of Indirect Carotid-Cavernous Fistula. J Neuroophthalmol 2021; 41:e743-e745. [PMID: 33136678 DOI: 10.1097/wno.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rebecca S George
- Division of Neurology (RSG, CEM), Department of Medicine, Dalhousie University, Halifax, Canada ; and Department of Ophthalmology and Visual Sciences (ASP, CEM), Dalhousie University, Halifax, Canada
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Bernath MM, Mathew S, Kovoor J. Craniofacial Trauma and Vascular Injury. Semin Intervent Radiol 2021; 38:45-52. [PMID: 33883801 PMCID: PMC8049762 DOI: 10.1055/s-0041-1724012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cerebrovascular injury is a potentially devastating outcome following craniofacial trauma. Interventional radiologists play an important role in detecting, grading, and treating the different types of vascular injury. Computed tomography angiography plays a significant role in the detection of these injuries. Carotid-cavernous fistulas, extra-axial hematomas, pseudoaneurysms, and arterial lacerations are rare vessel injuries resulting from craniofacial trauma. If left untreated, these injuries can lead to vessel rupture and hemorrhage into surrounding areas. Acute management of these vessel injuries includes early identification with angiography and treatment with endovascular embolization. Endovascular therapy resolves vessel abnormalities and reduces the risk of vessel rupture and associated complications.
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Affiliation(s)
- Megan M. Bernath
- Medical Scientist Training Program, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sunu Mathew
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jerry Kovoor
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
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6
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Huynh TJ, Morton RP, Levitt MR, Ghodke BV, Wink O, Hallam DK. Republished: Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique. J Neurointerv Surg 2020; 12:e8. [PMID: 33060177 DOI: 10.1136/neurintsurg-2017-013052.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 11/03/2022]
Abstract
We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture.
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Affiliation(s)
- Thien J Huynh
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Ryan P Morton
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Basavaraj V Ghodke
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Onno Wink
- Philips Healthcare, Bothell, Washington, USA
| | - Danial K Hallam
- Department of Radiology, University of Washington, Seattle, Washington, USA .,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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7
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Laplant JF, Lim LH, Dumont AS, Nerva JD. Transvenous embolization of bilateral indirect carotid-cavernous fistulas via a unilateral transorbital approach. Orbit 2020; 40:320-325. [PMID: 32552143 DOI: 10.1080/01676830.2020.1779753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 73-year-old man with a complex ophthalmologic history presented with several weeks of worsening diplopia, visual acuity, and proptosis bilaterally. Cerebral angiography demonstrated bilateral indirect Barrow type B carotid-cavernous fistulas (CCFs). Transarterial embolization was not attempted due to small arterial diameter and risk of stroke. Multiple attempts were made to access the fistula via a transfemoral venous approach and were unsuccessful. A transorbital puncture was performed, which allowed access to both cavernous sinuses via a unilateral approach. After embolization with Onyx, there was no residual fistula. The patient had a left-sided retrobulbar hematoma from the access. Right eye vision improved postoperatively.
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Affiliation(s)
| | - Lauren H Lim
- Department of Ophthalmology, Tulane University, New Orleans, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, USA
| | - John D Nerva
- Department of Neurological Surgery, Tulane University, New Orleans, USA
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Ertl L, Brückmann H, Patzig M, Fesl G. Endovascular therapy of direct dural carotid cavernous fistulas - A therapy assessment study including long-term follow-up patient interviews. PLoS One 2019; 14:e0223488. [PMID: 31622360 PMCID: PMC6797194 DOI: 10.1371/journal.pone.0223488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/22/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose Endovascular embolization nowadays is a well-established treatment option for direct carotid cavernous fistulas (dCCF, Barrow Type A). There are many publications on the complication and success rates of this method. However, little is known on the patients´ opinion on the treatment result after several years. We report on this issue also including the “pioneer patients” treated almost two decades ago. Methods We retrospectively reviewed the records of all patient (n = 25) with a more than 24 months follow-up interval after endovascular treatment of a dCCF at our institution from 01/1999 to 08/2018. We determined primary therapy success, complication rate, state of the fistula in the last imaging follow-up and quoted the patient’s subjective perception of the long-term treatment success using a standardized interview form. Results Occlusion rate in the last imaging follow up was 96% (24/25) with a complication rate of 8% (2/25). The response rate on our interview request was 96% (24/25) with a rate of considered feedback of 84% (21/25 patients). Duration of our observation interval for the patient reported outcome was 143 months / 11 years (median, range: 35–226 m / 2–18 y). Most of them (21/25, 84%) felt they benefited from the treatment. Conclusions Endovascular supply of dCCF is a highly effective treatment method leading to a sustainable therapy success with long-lasting stable subjective benefit even to our “pioneer patients” treated almost two decades ago.
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Affiliation(s)
- Lorenz Ertl
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
- Radiologie Augsburg-Friedberg ÜBAG, Augsburg, Germany
- * E-mail:
| | - Hartmut Brückmann
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Patzig
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Gunther Fesl
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
- Radiologie Augsburg-Friedberg ÜBAG, Augsburg, Germany
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Nossek E, Lombardo K, Schneider JR, Kwan K, Chalif DJ, Setton A. Unilateral Venous Approach to Contralateral or Bilateral Carotid Cavernous Shunts. World Neurosurg 2019; 133:e479-e486. [PMID: 31541756 DOI: 10.1016/j.wneu.2019.09.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cavernous carotid fistulas (CCF) are anatomically complex vascular lesions. Treatment via the venous approach has been previously described and is highly dependent on the patency of the drainage pathways. The use of a unilateral approach to contralateral or bilateral shunts is technically challenging and not commonly described. We present our experience with the unilateral across-the-midline approach to both cavernous sinuses to treat shunts according to anatomic compartments to achieve anatomic cure. METHODS Patients included in this study presented with either bilateral or unilateral shunts with unilateral venous drainage. We used a transarterial guiding catheter for road mapping and control angiography. A venous triaxial system was used to achieve support for distal navigation across the midline via the coronary sinus to the contralateral cavernous sinus. Coils were favored for embolization, with occasional complementary liquid embolic material. RESULTS Five patients underwent complete occlusion in a single session. One patient required additional complementary transarterial embolization. Despite a successful unilateral approach to bilateral cavernous sinuses, 1 patient needed an additional ipsilateral transophthalmic venous approach to obliterate the anterior compartment of the cavernous sinus. No complications were encountered. Complete angiographic cure was observed in all patients by the end of the final procedures, with persistent occlusion in their follow-up imaging. CONCLUSIONS Careful inspection of the venous anatomy and fistulization sites is critical when treating unilateral or bilateral carotid cavernous shunts. The contralateral venous route can serve as a safe approach when visualized. Crossing the midline via the anterior or posterior coronary sinuses is feasible and efficacious.
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Affiliation(s)
- Erez Nossek
- Department of Neurosurgery, NYU Medical Center, New York, New York, USA.
| | - Kim Lombardo
- Department of Neurosurgery, North-Shore Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
| | - Julia R Schneider
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York, USA
| | - Kevin Kwan
- Department of Neurosurgery, North-Shore Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
| | - David J Chalif
- Department of Neurosurgery, North-Shore Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
| | - Avi Setton
- Department of Neurosurgery, North-Shore Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA; Department of Radiology, North-Shore Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
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10
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Sellar and Parasellar Pain Syndromes. Curr Pain Headache Rep 2019; 23:7. [PMID: 30712067 DOI: 10.1007/s11916-019-0740-x] [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: 10/27/2022]
Abstract
PURPOSE OF REVIEW Sellar and parasellar lesions are numerous and varying in terms of their patholphysiology and physical and radiographic characteristics but often incite pain syndromes that are similar in semiology. The goal of this review was to familiarize the reader with a variety of sellar and parasellar lesions grouped together based on common clinical symptomatology, with a focus on important imaging characteristics that are often distinguishing features diagnostically. RECENT FINDINGS In most cases, tissue acquisition via surgical resection or stereotactic biopsy are the mainstay for definitive diagnosis of sellar and parasellar lesions. With advances in MRI technology in particular in terms of resolution and the inclusion of new techniques including dynamic imaging with delayed contrast, imaging studies of lesions in the sellar and parasellar regions have become increasingly important for diagnostic purposes, with pituitary adenomas and schwannomas as prime examples. In the case of chordoid gliomas, molecular features of the tumor also help distinguish it from other disease processes similar in presentation, which have dramatic impacts on management. Advances in surgical approaches and radiation techniques offer more precise and targeted therapy to lesions in an area with increased risk of clinical morbidity given the high concentration of critically important structures that must be spared during treatment. Sellar and parasellar lesions have the potential to cause significant morbidity and mortality, highlighting the importance of clinical recognition of warning signs/symptoms, obtaining high-quality imaging studies in various modalities for diagnostic purposes, and prompt management which often involves a multimodal approach that includes surgical resection, radiation, and/or medical therapy. Future advanced imaging techniques will only improve presurgical diagnostic accuracy and lead to more prompt and efficient management.
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11
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Alexander MD, Halbach VV, Hallam DK, Cooke DL, Ghodke BV, Dowd CF, Amans MR, Hetts SW, Higashida RT, Meyers PM. Long-Term Outcomes of Endovascular Treatment of Indirect Carotid Cavernous Fistulae: Superior Efficacy, Safety, and Durability of Transvenous Coiling Over Other Techniques. Neurosurgery 2018; 85:E94-E100. [DOI: 10.1093/neuros/nyy486] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew D Alexander
- Departments of Radiology & Imaging Sciences and Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Van V Halbach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Danial K Hallam
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | | | - Christopher F Dowd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Randall T Higashida
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Philip M Meyers
- Departments of Radiology and Neurosurgery, Columbia University College of Physicians & Surgeons, New York, New York
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Konstas AA, Song A, Song J, Thanos A, Ross IB. Embolization of a cavernous carotid fistula through the vein of Labbé: a new alternative transvenous access route. J Neurointerv Surg 2018; 10:e11. [PMID: 29627790 DOI: 10.1136/neurintsurg-2017-013229.rep] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/04/2022]
Abstract
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 61-year-old 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 the only venous outflow from the cavernous sinus. Access to the CCF was made possible after careful navigation of the sigmoid sinus, the vein of Labbé and the SMCV, bypassing the need for surgical access to the SMCV or for a direct transorbital puncture. The CCF was completely occluded by coiling and Onyx embolization. The patient made an uneventful recovery, with resolution of her symptoms. To the best of our knowledge, this access route has not been previously reported in the treatment of CCFs.
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Affiliation(s)
| | - Alice Song
- Center for Oculofacial and Orbital Surgery, Los Angeles, California, USA
| | - Julia Song
- Southern California Eye Physicians and Surgeons, Los Angeles, California, USA
| | | | - Ian B Ross
- Department of Neurosurgery, Huntington Memorial Hospital, Pasadena, California, USA
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Konstas AA, Song A, Song J, Thanos A, Ross IB. Embolization of a cavernous carotid fistula through the vein of Labbé: a new alternative transvenous access route. BMJ Case Rep 2017; 2017:bcr-2017-013229. [PMID: 28963167 DOI: 10.1136/bcr-2017-013229] [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: 11/04/2022] Open
Abstract
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 61-year-old 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 the only venous outflow from the cavernous sinus. Access to the CCF was made possible after careful navigation of the sigmoid sinus, the vein of Labbé and the SMCV, bypassing the need for surgical access to the SMCV or for a direct transorbital puncture. The CCF was completely occluded by coiling and Onyx embolization. The patient made an uneventful recovery, with resolution of her symptoms. To the best of our knowledge, this access route has not been previously reported in the treatment of CCFs.
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Affiliation(s)
| | - Alice Song
- Center for Oculofacial and Orbital Surgery, Los Angeles, California, USA
| | - Julia Song
- Southern California Eye Physicians and Surgeons, Los Angeles, California, USA
| | | | - Ian B Ross
- Department of Neurosurgery, Huntington Memorial Hospital, Pasadena, California, USA
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14
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Huynh TJ, Morton RP, Levitt MR, Ghodke BV, Wink O, Hallam DK. Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique. BMJ Case Rep 2017; 2017:bcr-2017-013052. [PMID: 28824011 DOI: 10.1136/bcr-2017-013052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture.
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Affiliation(s)
- Thien J Huynh
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Ryan P Morton
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Basavaraj V Ghodke
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Onno Wink
- Philips Healthcare, Bothell, Washington, USA
| | - Danial K Hallam
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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15
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Abecassis IJ, Morton RP, Kim LJ, Ghodke BV, Levitt MR. Combined direct and indirect traumatic carotid-cavernous fistula (CCF): Case report and review of the literature. J Clin Neurosci 2017; 44:240-242. [PMID: 28712734 DOI: 10.1016/j.jocn.2017.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Within the current Barrow classification system, there are no categorical descriptions or reports in the literature of cavernous carotid fistulas (CCFs) with both a direct component (type A) and separate indirect contribution (type B, C, or D). We report the first definitive case of a combined simultaneous traumatic direct and indirect CCF, and review the literature on the similar existing entity of traumatic indirect CCFs presenting delayed and subsequent to the treatment of traumatic, direct CCFs. METHODS We report a case of simultaneous direct type A CCF with a traumatic indirect CCF component and a review of the relevant literature. RESULTS An 18year-old female presented after a motor vehicle collision. A diagnostic cerebral angiogram confirmed the diagnosis of CCF, with contribution both directly from the ICA and indirectly via branches of the ECA. The direct component of the CCF was first treated in 3 stages via both transarterial and transvenous coil embolization, followed by a final 4th stage of parent vessel sacrifice in order to treat the residual direct component, with transarterial embolization to treat residual indirect CCF activity. CONCLUSIONS To our knowledge, this is the first report of a traumatic CCF with simultaneous direct (type A) and indirect via the ECA (type C) contributions.
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Affiliation(s)
- Isaac Josh Abecassis
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Ryan P Morton
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States; Department of Radiology, University of Washington, Seattle, WA, United States
| | - Basavaraj V Ghodke
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States; Department of Radiology, University of Washington, Seattle, WA, United States
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States; Department of Radiology, University of Washington, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
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Fenstermaker R, Abad A. Imaging of Pituitary and Parasellar Disorders. Continuum (Minneap Minn) 2016; 22:1574-1594. [DOI: 10.1212/con.0000000000000380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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MITSUHASHI Y, HAYASAKI K, KAWAKAMI T, NAGATA T, KANESHIRO Y, UMABA R, OHATA K. Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations. Neurol Med Chir (Tokyo) 2016; 56:326-39. [PMID: 27063146 PMCID: PMC4908076 DOI: 10.2176/nmc.ra.2015-0346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/09/2016] [Indexed: 11/22/2022] Open
Abstract
The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery "medial venous axis" carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves "lateral venous axis" are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves "intermediate venous axis" contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage.
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Affiliation(s)
- Yutaka MITSUHASHI
- Department of Neurosurgery, Ishikiri-Seiki Hospital, Higashiosaka, Osaka
| | - Koji HAYASAKI
- Department of Neurosurgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, Hirakata, Osaka
| | - Taichiro KAWAKAMI
- Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Osaka
| | - Takashi NAGATA
- Department of Neurosurgery, Ishikiri-Seiki Hospital, Higashiosaka, Osaka
| | - Yuta KANESHIRO
- Department of Neurosurgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, Hirakata, Osaka
| | - Ryoko UMABA
- Department of Neurosurgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Osaka
| | - Kenji OHATA
- Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Osaka
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