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Crowe JR, Regenhardt RW, Dmytriw AA, Vranic JE, Stapleton CJ, Patel AB. Deconstructive repair of a direct carotid-cavernous fistula via a posterior circulation retrograde approach. J Cerebrovasc Endovasc Neurosurg 2024:jcen.2024.E2023.05.001. [PMID: 38523550 DOI: 10.7461/jcen.2024.e2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
We report a case of a 24-year-old patient who presented after a head trauma with a traumatic occlusion of his left internal carotid artery. He underwent diagnostic cerebral angiogram and was found to have a direct left carotid-cavernous fistula (CCF) with retrograde filling from the posterior circulation across the posterior communicating artery. Because of the severe injury to the left internal carotid artery (ICA), reconstructive repair of the ICA was not possible. The patient underwent deconstructive repair of the CCF by coil embolization using a posterior retrograde approach. Coils were successfully placed in the cavernous sinus and back into the left ICA with complete cure of the CCF and restoration of cerebral perfusion distal to the treated CCF. We review the types of CCFs, their clinical presentation, and their endovascular treatments. Retrograde access of a direct CCF is rarely reported in the literature, and we believe this approach offers a viable alternative in appropriately selected patients.
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Affiliation(s)
- Jonathan R Crowe
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
- Brigham and Women's Hospital, Department of Neurology, 75 Francis Street, Boston, MA
| | - Robert W Regenhardt
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
| | - Adam A Dmytriw
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
| | - Justin E Vranic
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
| | | | - Aman B Patel
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
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2
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González Gómez JF, Di Lizio-Miele G, Arias Rojas BC, Sierra Vargas PA. Transradial access embolization of carotid-cavernous fistulae: Case report. J Vasc Access 2024:11297298231225247. [PMID: 38242841 DOI: 10.1177/11297298231225247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Carotid-Cavernous sinus fistula (CCF) represents a misdiagnosed condition with potential repercussion in functional, neurological, and social roles of patients with this disease. Earlier reports remark on the efficiency and safety of endovascular therapy with resolution of the symptoms were performed appropriately. We present a case of a male patient from a developing country, with gunshot wound head trauma history and short-term progressive functional and neurological impairment in the presence of intracranial hypertension and ocular symptoms who developed a large CFF, subsequently treated by transradial access embolization. We aim to describe the real-world experience in diagnosis and treatment of CCFs, emphasizing on the scope and outcomes of the endovascular treatment. This case supports worldwide experience, positioning endovascular therapy as an effective strategy in the resolution of CFFs, and the relevance of suspecting this disease in the presence of typical symptoms, even if they are rapidly progressive.
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3
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Andreev A, McMillan N, Money K, Shutran M, Ogilvy C. Parent artery occlusion of a giant internal carotid artery pseudoaneurysm-related direct carotid cavernous fistula: A case report. J Cerebrovasc Endovasc Neurosurg 2023; 25:306-310. [PMID: 36623887 PMCID: PMC10555626 DOI: 10.7461/jcen.2023.e2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 01/11/2023] Open
Abstract
Traumatic internal carotid artery injuries can produce direct carotid-cavernous fistulas as well as giant internal carotid artery pseudoaneurysms. Clinical sequelae can include headaches, cranial nerves palsies, proptosis, chemosis and optic neuropathy with visual loss as the most dangerous complication. Herein, we present a case of one of the largest reported internal carotid artery pseudoaneurysms associated with a direct carotid cavernous fistula. We describe the techniques and pitfalls of treatment with parent vessel occlusion.
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Affiliation(s)
- Alexander Andreev
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Nadia McMillan
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Kelli Money
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Max Shutran
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Christopher Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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4
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Greslechner R, Helbig H, Spiegel D. [Secondary open-angle glaucoma: uveitic secondary glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, tumor-related glaucoma and glaucoma due to elevated episcleral venous pressure]. Ophthalmologe 2022. [PMID: 35471612 DOI: 10.1007/s00347-022-01630-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure (IOP). In contrast to primary open-angle glaucoma in many cases besides IOP reduction a causal treatment is possible. This article is the second part of a review of the more frequently encountered forms of secondary open-angle glaucoma. Uveitic glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, glaucoma due to intraocular tumors and caused by elevated episcleral venous pressure are covered. The underlying pathophysiological mechanisms, characteristic clinical findings and treatment options are discussed.
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Pagiola I, Amaral B, Saito C, Nalli D, Junior HC, Frudit M. Is the retrograde access for endovascular treatment of a traumatic carotid cavernous fistula associated with dissection of the ipsilateral carotid possible? J Cerebrovasc Endovasc Neurosurg 2021; 23:54-59. [PMID: 33725761 PMCID: PMC8041509 DOI: 10.7461/jcen.2021.e2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022] Open
Abstract
This is a case demonstrating a combined traumatic lesion of the internal carotid artery (dissection and a carotid cavernous fistula [CCF]) in a patient who was beaten during a robbery and, while trying to escape, was hit by a vehicle. Endovascular approach for the treatment was chosen using the retrograde access from the vertebral artery to the cavernous sinus by posterior communicating (Pcom) artery due to the occlusion of the ipsilateral internal carotid. Because the artery access by the internal carotid was impossible, retrograde approach by vertebral artery and Pcom artery was done to treat the direct CCF. A patient presented with left hemiplegia and proptosis, chemosis, right eye ptosis. Computed tomography (CT) and CT angiography revealed a CCF of the right carotid. An arterial retrograde endovascular approach by the vertebral artery was used for CCF occlusion with coils. We present a rare case of a combined traumatic cerebrovascular lesion, right carotid artery dissection and a right direct CCF treated by a retrograde endovascular approach by the vertebral artery through the Pcom artery to reach the fistula point and achieved a complete cure of the CCF.
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Affiliation(s)
- Igor Pagiola
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Department of Interventional Neuroradiology, Hospital Estadual Central, VitÓria ES, Brazil
| | - Bruno Amaral
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Celso Saito
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Darcio Nalli
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Henrique Carrete Junior
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Michel Frudit
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Son W, Kang DH, Park J, Kwak Y, Kim M, Kim BJ. Advantage of Balloon Guide Catheter During Endovascular Treatment of Direct Carotid-Cavernous Sinus Fistula: Technical Note and Report of 2 Cases. World Neurosurg 2020; 145:251-255. [PMID: 32977031 DOI: 10.1016/j.wneu.2020.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND As previous studies reported, the balloon guide catheter is useful for identifying the fistula point during diagnosis of direct carotid-cavernous sinus fistula (d-CCF). We demonstrate an additional advantage of the balloon guide catheter during intraarterial endovascular treatment of d-CCF. METHODS Two cases of d-CCF are presented in this report. A balloon guide catheter is used to help achieve successful coil embolization of the fistula in both cases. RESULTS Microcatheter positioning into the fistulous point can be easier after balloon inflation. Balloon inflation can help with coil deployment. CONCLUSIONS Using a balloon guiding catheter can reduce internal carotid artery flow near the fistula point at the cavernous segment of the internal carotid artery. As a result, better identification of the fistula point can be made, which allows easier placement of the microcatheter into the fistula point and more stable coil deployment.
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Affiliation(s)
- Wonsoo Son
- Departments of Neurosurgery, School of Medicine Kyungpook National University, Daegu, Republic of Korea
| | - Dong-Hun Kang
- Departments of Neurosurgery, School of Medicine Kyungpook National University, Daegu, Republic of Korea; Department of Radiology, School of Medicine Kyungpook National University, Daegu, Republic of Korea.
| | - Jaechan Park
- Departments of Neurosurgery, School of Medicine Kyungpook National University, Daegu, Republic of Korea
| | - Youngseok Kwak
- Departments of Neurosurgery, School of Medicine Kyungpook National University, Daegu, Republic of Korea
| | - Myungsoo Kim
- Departments of Neurosurgery, School of Medicine Kyungpook National University, Daegu, Republic of Korea
| | - Byung-Jun Kim
- Departments of Neurosurgery, School of Medicine Kyungpook National University, Daegu, Republic of Korea
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Gomez-Paz S, Vergara-Garcia D, Robinson M, Kicielinski KP, Thomas AJ, Ogilvy CS. Coil Embolization of a Carotid-Cavernous Fistula Through Superior Ophthalmic Venous Access via External Jugular Vein Puncture Approach. World Neurosurg 2019; 131:196. [PMID: 31421303 DOI: 10.1016/j.wneu.2019.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
Carotid-cavernous fistulas are vascular malformations that pose a risk for intracranial hemorrhage when there is documented cortical venous drainage. When possible, treatment with transvenous embolization has become the technique of choice since the late 1990s.1,2 We present a case of a patient with a carotid-cavernous fistula treated with venous coil embolization via a jugular venous approach. The patient was a 59-year-old female with a history of intense headaches. Initial magnetic resonance imaging showed congestion in the right cavernous sinus, and a diagnostic angiogram revealed a cavernous carotid fistula Thomas type 4.3,4 Given the presence of retrograde cortical venous drainage, we decided to treat the lesion. A femoral route for endovascular treatment was attempted, but it was unsuccessful in traversing the external jugular vein due to venous valves. We accessed the fistula through a direct puncture direct proximal approach,5 from the external jugular vein making our trajectory through the facial-angular-supraorbital vein, ultimately reaching the cavernous sinus. We then filled the sinus with coils to obliterate the fistula. The patient awakened neurologically intact, and a postoperative angiogram demonstrated complete occlusion of the lesion. The patient was discharged at postoperative day 1 without complications. In this video, we narrate the important details of this alternative when a traditional route is inaccessible (Video 1). Informed consent was obtained for the case illustrated; however, neither Institutional Review Board nor patient consent is required for the report of a single case in which no identifiable patient information is shared.
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Affiliation(s)
- Santiago Gomez-Paz
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Vergara-Garcia
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matt Robinson
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly P Kicielinski
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Otiniano Sifuentes R, Vélez Rojas M, Flores Mendoza M, Torres Ramírez L, Solís Chucos F. Brainstem venous congestion due to a direct carotid-cavernous fistula: Case report. Neurocirugia (Astur) 2019; 31:98-102. [PMID: 31377094 DOI: 10.1016/j.neucir.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/06/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
Abstract
A 50-year-old male patient who, after 3 months of cranial brain trauma, presented proptosis, chemosis and exophthalmos in the left eye. Subsequently, dysmetria develops in the left extremities and right hemiparesis. The diagnosis of carotid-cavernous fistula (FCC) associated with hyperintensity of signal in FLAIR and diffuse contrast uptake at the level of the pseudo tumoral protuberance and cerebellar peduncle was established. This finding was compatible with venous congestion. His symptoms were fluctuating, he started with orbital symptoms and then from the posterior fossa with improvement of the orbital symptoms. FCC microcoil embolization produced resolution of ocular symptoms followed by improvement of brainstem symptoms. Magnetic resonance findings significantly reversed one year of follow-up. We describe a case of direct FCC with venous congestion in the brainstem and fluctuating symptoms with a considerable clinical and imaging improvement after treatment.
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Affiliation(s)
| | - Miriam Vélez Rojas
- Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Martha Flores Mendoza
- Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Luis Torres Ramírez
- Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Frank Solís Chucos
- Departamento de Microneurocirugía, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
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9
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Shim HS, Kang KJ, Choi HJ, Jeong YJ, Byeon JH. Delayed contralateral traumatic carotid cavernous fistula after craniomaxillofacial fractures. Arch Craniofac Surg 2019; 20:44-47. [PMID: 30840818 PMCID: PMC6411523 DOI: 10.7181/acfs.2018.02215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/28/2019] [Indexed: 11/11/2022] Open
Abstract
A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.
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Affiliation(s)
- Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kyo Joon Kang
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Hyuk Joon Choi
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Yeon Jin Jeong
- Department of Plastic and Reconstructive Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Hee Byeon
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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10
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Imrie A, Redmond K, Leggett D. Spontaneous direct carotid-cavernous sinus fistula secondary to a persistent primitive trigeminal artery treated by trans-venous coil embolisation. Interv Neuroradiol 2018; 24:567-570. [PMID: 29754515 DOI: 10.1177/1591019918774241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A healthy 51-year-old female presented with a spontaneous direct carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. She had no history of connective tissue or cerebrovascular disorders or significant head trauma. This is a rare lesion with only 18 previously reported cases. It had similar clinical presentation and imaging appearance to a high-flow direct carotid-cavernous fistula and was uncovered after successful trans-venous coil embolisation of the fistula. It therefore needs to be considered in cases of direct carotid-cavernous fistula without history of trauma. Knowledge of types of persistent primitive trigeminal artery is also important for their critical treatment implications.
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Affiliation(s)
- Andrew Imrie
- Department of Medical Imaging, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kendal Redmond
- Department of Medical Imaging, Princess Alexandra Hospital, Woolloongabba, Australia
| | - David Leggett
- Department of Medical Imaging, Princess Alexandra Hospital, Woolloongabba, Australia
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11
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Park SH, Park KS, Kang DH, Hwang JH, Hwang SK. Stereotactic Radiosurgery for Dural Carotid Cavernous Sinus Fistulas. World Neurosurg 2017; 106:836-843. [PMID: 28465265 DOI: 10.1016/j.wneu.2017.04.143] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We reviewed our 7-year experience to assess the efficacy of stereotactic radiosurgery (SRS) for dural carotid cavernous fistulas (DCCFs). We analyzed the clinical outcome, complications, and angiographic results. METHODS We performed a retrospective analysis of 18 consecutive patients with DCCFs treated by SRS alone using Gamma Knife between 2009 and 2015. Median target volume was 2.6 cm3 (range, 0.6-11.6 cm3), and median radiation dose to the target was 17 Gy (range, 14-19 Gy). Median follow-up period was 30 months (range, 6-65 months). RESULTS Fifteen patients (83%) achieved total obliteration of the DCCF, and a subtotal obliteration of the DCCF was achieved in 3 patients (17%). Total obliteration rates after SRS were 53% at 1 year and 90% at 2 years. Twelve patients (67%) showed complete recovery from symptoms or signs, and 6 patients (33%) showed incomplete recovery. Improvement rates of neurologic function after SRS were 56% at 1 month, 72% at 3 months, and 94% at 6 months. None of the patients experienced radiation-related complications. A univariate analysis revealed that absence of hypertension (P = 0.025), seizure (P = 0.025), and cortical venous drainage (P = 0.013) were significantly associated with symptoms improvement. CONCLUSIONS SRS for DCCFs offered a high obliteration rate with low risk of radiation-induced complications. In patients with benign DCCFs that are not amenable to embolization or microsurgery, SRS is a safe and effective treatment for complete obliteration of the arteriovenous shunt and for improving quality of life.
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Affiliation(s)
- Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea.
| | - Ki-Su Park
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea; Department of Radiation, Kyungpook National University Hospital, Daegu, South Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Sung-Kyoo Hwang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea
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12
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Gatto LAM, Tacla R, Koppe GL, Junior ZD. Carotid cavernous fistula after percutaneous balloon compression for trigeminal neuralgia: Endovascular treatment with coils. Surg Neurol Int 2017; 8:36. [PMID: 28458950 PMCID: PMC5369261 DOI: 10.4103/sni.sni_443_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/17/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Percutaneous ganglyolysis treatment of trigeminal neuralgia is rarely associated with vascular complications, such as hematoma, subarachnoid hemorrhage, and stroke. Internal carotid artery injury may also occur after misguided needle placement, particularly far posteriorly or medially, resulting in carotid cavernous fistula. Anatomical variations of the foramen ovale can predispose those complications. CASE DESCRIPTION A young woman diagnosed with trigeminal neuralgia during 11 years was submitted to a balloon rhizotomy by percutaneous approach to the trigeminal ganglion, with severe intraoperative bleeding. Cavernous syndrome developed few hours later. Magnetic resonance imaging and digital subtraction angiography confirmed an indirect carotid cavernous sinus fistula, which was treated by one session of endovascular procedure using coils, achieving total occlusion of the fistula and total recovery of the symptoms. CONCLUSIONS Embolization with coils is a minimally invasive, safe, and effective procedure for the treatment of carotid cavernous fistulas, including those related to iatrogenic causes.
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Affiliation(s)
- Luana A M Gatto
- Department of Neurosurgery and Interventional Neuroradiology, University Hospital Cajuru of Catholic Pontifical University (HUC-PUC), Curitiba, Parana, Brazil
| | - Rafaella Tacla
- Department of Neurosurgery and Interventional Neuroradiology, University Hospital Cajuru of Catholic Pontifical University (HUC-PUC), Curitiba, Parana, Brazil
| | - Gelson L Koppe
- Department of Neurosurgery and Interventional Neuroradiology, University Hospital Cajuru of Catholic Pontifical University (HUC-PUC), Curitiba, Parana, Brazil
| | - Zeferino Demartini Junior
- Department of Neurosurgery and Interventional Neuroradiology, University Hospital Cajuru of Catholic Pontifical University (HUC-PUC), Curitiba, Parana, Brazil
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13
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Abstract
Background Recently, applications of optical coherence tomography angiography (OCTA) have been limited to the retina and posterior segment. Although early studies have described its use for other clinical applications, its role in anterior segment vasculature and optic disc imaging has been limited thus far. Case presentation We describe a novel clinical application of OCTA in a patient with dural carotid-cavernous sinus fistula (CCF), which was complicated by increased intra-ocular pressure (IOP). In this case report, we used the OCTA to delineate increased epsicleral venous flow in the affected eye with secondary raised IOP. Current measurements of episcleral venous pressure are either invasive or provide highly variable results, thus the OCTA may have the potential to provide a more reliable approach to assess episcleral vasculature. We also describe the use of OCTA to detect early glaucomatous nerve damage, associated with focal reductions in peripapillary retinal perfusion. Conclusions We present an early report of using OCTA of the anterior segment to allow rapid, non-invasive delineation of abnormal episcleral venous plexus secondary to dural CCF. The OCTA was also useful for detecting early reduction in peripapillary retinal perfusion, which suggests early glaucomatous optic neuropathy. This suggests that OCTA may have a role for determining risk of glaucoma in patients with CCF in future.
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Affiliation(s)
- Marcus Ang
- Singapore National Eye Center, Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore. .,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore, Singapore.
| | - Chelvin Sng
- National University Health System, Singapore, Singapore
| | - Dan Milea
- Singapore National Eye Center, Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore, Singapore
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14
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Venturini M, Cristel G, Marzoli SB, Simionato F, Agostini G, Barboni P, De Cobelli F, Falini A, Bandello F, Del Maschio A. Orbital color Doppler ultrasound as noninvasive tool in the diagnosis of anterior-draining carotid-cavernous fistula. Radiol Med 2015; 121:301-7. [PMID: 26639150 DOI: 10.1007/s11547-015-0607-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the role of orbital color Doppler ultrasound (OCDUS) in the diagnosis of carotid-cavernous fistula (CCF) with anterior drainage and particularly whether a negative OCDUS could avoid an invasive diagnostic cerebral angiography (DSA). MATERIALS AND METHODS Twenty-two consecutive patients with ophthalmic signs suspecting CCF were submitted to ophthalmologic examination, OCDUS and DSA. CCF diagnosis with OCDUS was based on the finding of a reversed, arterialized and low-resistive-index (RI <0.5) blood flow in the superior ophthalmic vein (SOV). Sensibility, specificity, PPV, NPV, and accuracy of OCDUS were calculated considering both patients and eyes, using DSA as gold standard. RESULTS DSA demonstrated 20 CCFs in 18 patients. Considering the patients, in 18/22 CCF diagnosis was positive at OCDUS and DSA while 4/22 were negative at both. Considering the eyes, in 24/43 CCF diagnosis was positive at both DSA and OCDUS (total eyes = 43, due to one case of SOV thrombosis). In 19/43 eyes diagnosis was negative at both OCDUS and DSA. So sensitivity, specificity, PPV, NPV, and accuracy of OCDUS in the patients and eyes analysis were all 100 %. CONCLUSIONS OCDUS is a reliable, noninvasive tool in the diagnosis of CCF; a negative OCDUS could avoid an invasive DSA in patients suspected for anterior-draining CCF.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.
| | - Giulia Cristel
- Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Franco Simionato
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Agostini
- Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Piero Barboni
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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15
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Abstract
AIM To present a novel approach to treatment of dural carotid-cavernous fistulas via the medial ophthalmic vein. DESIGN Retrospective case series. MATERIAL AND METHODS In this retrospective case series, we present 2 patients (3 eyes) with Type C dural CCFs, who had failed cannulation via the conventional transfemoral route and the transorbital superior ophthalmic vein approach. They subsequently underwent CCF occlusion via an anterior orbital approach through the medial ophthalmic veins, at the Department of Ophthalmology, National University Hospital Singapore. CCF occlusion was confirmed intraoperatively using angiography. Both patients were evaluated postoperatively for best-corrected visual acuity and resolution of clinical signs and symptoms. RESULTS Successful occlusion of CCFs via the medial ophthalmic veins were achieved in all three orbits, with excellent visual and cosmetic outcomes postoperatively. CONCLUSION Dural CCFs may potentially lead to severe visual dysfunction and should be diagnosed and treated promptly. When all venous routes have been exhausted, the transorbital approach via the medial ophthalmic vein remains an excellent and viable alternative to access the fistula. Close cooperation between the orbital, anesthetic and radiological teams is essential in ensuring success of the operation.
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Affiliation(s)
- Nigel C S Lim
- a Department of Ophthalmology , National University Health System , Singapore and
| | - Hazel Anne H E Lin
- a Department of Ophthalmology , National University Health System , Singapore and
| | - Cheng Kang Ong
- b Parkway Radiology, Mount Elizabeth Hospital , Singapore
| | - Gangadhara Sundar
- a Department of Ophthalmology , National University Health System , Singapore and
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16
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Pouw AE, Rabin RL, Karanjia R, Bababeygy SR, Amar AP, Sadun AA. Angioarchitectural evolution of clival dural arteriovenous fistulas in two patients. Case Rep Ophthalmol 2015; 6:93-100. [PMID: 25873894 PMCID: PMC4386113 DOI: 10.1159/000381176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dural arteriovenous fistulas (dAVFs) may present in a variety of ways, including as carotid-cavernous sinus fistulas. The ophthalmologic sequelae of carotid-cavernous sinus fistulas are known and recognizable, but less commonly seen is the rare clival fistula. Clival dAVFs may have a variety of potential anatomical configurations but are defined by the involvement of the venous plexus just overlying the bony clivus. Here we present two cases of clival dAVFs that most likely evolved from carotid-cavernous sinus fistulas.
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Affiliation(s)
- Andrew E Pouw
- Keck School of Medicine, University of Southern California, Calif., USA
| | - Richard L Rabin
- Department of Ophthalmology, Nassau University Medical Center, East Meadow, N.Y., USA
| | - Rustum Karanjia
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, Calif., USA
| | - Simon R Bababeygy
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, Calif., USA
| | - Arun P Amar
- Keck School of Medicine, University of Southern California, Calif., USA
| | - Alfredo A Sadun
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, Calif., USA
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17
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de Dompablo E, Díez-Álvarez L, Ruiz-Casas D, Sánchez-Gutiérrez V, Ciancas E, González-López JJ. [Recurrent neurosensory macular detachment in carotid-cavernous fistula]. ACTA ACUST UNITED AC 2014; 90:331-4. [PMID: 25443195 DOI: 10.1016/j.oftal.2014.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 02/08/2014] [Accepted: 03/18/2014] [Indexed: 11/26/2022]
Abstract
CASE REPORT A 46 year-old man was seen in the emergency department complaining of vision loss and exophthalmos in his right eye. He also complained of headache, diplopia of 4 months onset, and neurosensory detachment that resolved spontaneously the month before. The study revealed tortuous conjunctival and episcleral vessels and neurosensory macular detachment in his right eye. A carotid-cavernous fistula was confirmed by computed tomography angiography. The fistula closed spontaneously during the hospitalization. One month later, the neurosensory detachment disappeared again. DISCUSSION Carotid-cavernous fistula should be included in the differential diagnosis of neurosensory macular detachments. These neurosensory detachments can resolve spontaneously 11 the fistula is closed.
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Affiliation(s)
- E de Dompablo
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - L Díez-Álvarez
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - D Ruiz-Casas
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Sánchez-Gutiérrez
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Ciancas
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J J González-López
- Departamento de Retina Médica, Moorfields Eye Hospital NHS Foundation Trust, Londres, Reino Unido
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