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Cohen DA, Sanchez Moreno FR, Bhatti MT, Lanzino G, Chen JJ. Evaluating the Incidence and Neuro-Ophthalmic Manifestations of Carotid-Cavernous Fistulas. J Neuroophthalmol 2024; 44:232-235. [PMID: 37581565 PMCID: PMC10864674 DOI: 10.1097/wno.0000000000001973] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND To determine the incidence of carotid-cavernous fistula (CCF) and describe the neuro-ophthalmic manifestations and eventual clinical outcomes. METHODS This was a population-based, retrospective cohort study using the Rochester Epidemiology Project to identify patients aged 18 years or older residing in Olmsted County, MN, diagnosed with CCF from 1997 to 2019. The medical records were reviewed for ophthalmic signs and symptoms, including conjunctival chemosis, proptosis, orbital bruit, diplopia, ophthalmoplegia, orbital pain, ocular hypertension, and blurred vision. Also determined was the number of patients with CCF found incidentally on neuroimaging, without clinical manifestations. RESULTS Ten patients were diagnosed with a CCF between 1997 and 2019 with an overall incidence rate of 0.37 per 100,000 per year (95% CI 0.20-0.68). The median age was 50.5 years (range 23-74 years), 6 (60%) were female, and 9 were White and 1 patient was Korean. Three patients (30%) were asymptomatic and found incidentally on imaging that was obtained for unrelated reasons, and one patient's ocular details were unavailable because she passed away from severe head trauma. The following neuro-ophthalmologic or ocular manifestations were identified in the remaining 6 patients: chemosis/conjunctival injection (n = 6), cranial nerve (CN) VI palsy (n = 6), CN III palsy (n = 2), proptosis (n = 4), ocular/orbital pain (n = 3), audible orbital bruit (n = 2), ocular hypertension (n = 1), and blurred vision (n = 1). Of those patients with symptomatic CCFs, all underwent treatment except for one that spontaneously resolved. None of the patients suffered a stroke or cerebral hemorrhage. The 3 patients with incidentally discovered CCFs were asymptomatic and did not require treatment. CONCLUSIONS This is the first population-based study to show a low incidence rate of CCFs, supporting the notion that it is an uncommon condition. Neuro-ophthalmic manifestations are common, especially chemosis/conjunctival injection and CN VI palsy. Up to a third of patients with CCF can be asymptomatic and may be found incidentally on neuroimaging during the evaluation for unrelated symptoms.
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Affiliation(s)
- Devon A. Cohen
- Department of Ophthalmology, Cleveland Clinic Foundation, Cleveland, OH
| | | | - M. Tariq Bhatti
- Department of Ophthalmology, The Permanente Medical Group, Roseville, CA
| | | | - John J. Chen
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Luo N, Chen S, Liu B. Choroidal Vascular Alterations in Spontaneous Carotid-Cavernous Fistula. Ophthalmology 2024; 131:576. [PMID: 37656089 DOI: 10.1016/j.ophtha.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Nan Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shida Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Bingqian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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3
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Kesper C, Skalej M, Huth A, Viestenz A, Heichel J. Pressure-Lowering Effect of Interventional Fistula Occlusion in Secondary Glaucoma due to Orbital Draining Intracerebral Fistulae. Klin Monbl Augenheilkd 2024; 241:39-47. [PMID: 37524090 DOI: 10.1055/a-2040-4219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Carotid cavernous sinus fistulas (CSCF) are pathological connections of the internal and/or external carotid artery (and/or its branches) to the cavernous sinus. Ophthalmological symptoms and problems occur particularly when drainage is via the superior ophthalmic vein. MATERIAL AND METHODS Seven eyes of six patients with a high-grade suspicion of CSCF were included in this retrospective monocentric study. Digital subtraction angiography (DSA) was performed in the included patients, where an interventional fistula closure was performed in the case of CSCF. Four of the six patients received a pre- and post-interventional day-night intraocular pressure profile. Furthermore, medical history, symptoms, visual acuity, slit lamp microscopic findings, and DSA findings were evaluated. RESULTS The most common symptoms reported by patients were red eyes, diplopia, and exophthalmos. When the intraocular pressure (IOP) was measured, 83.33% of the patients showed increased values. The mean IOP in the day-night intraocular pressure profile in the affected eye before intervention was 23.5 (± 2.7) mmHg compared to 14.1 (± 2.3) mmHg in the healthy eye. A significant difference could thus be demonstrated in side comparison (p = 0.0047). The post-interventional measurement showed a mean IOP of 15.3 (± 1.0) mmHg in the affected eye and thus a significant difference to the pre-interventional measurement in the affected eye (p = 0.0018). Four of the six patients with CSCF were taking antiglaucomatous eye drops before the intervention, and two patients after the intervention. The number of antiglaucoma drugs used could also be reduced. CONCLUSION Interventional fistula closure is an effective method for treating the secondary increase of IOP in CSCF. Successful closure of the fistula showed a significant reduction in IOP, which was not possible with the sole administration of antiglaucoma drugs. Radius-Maumenee syndrome should be considered as a differential diagnosis.
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Affiliation(s)
- Christiane Kesper
- Universitäts- und Poliklinik für Augenheilkunde Halle (Saale), Halle (Saale), Deutschland
| | - Martin Skalej
- Klinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Andrea Huth
- Universitäts- und Poliklinik für Augenheilkunde Halle (Saale), Halle (Saale), Deutschland
| | - Arne Viestenz
- Universitäts- und Poliklinik für Augenheilkunde Halle (Saale), Halle (Saale), Deutschland
| | - Jens Heichel
- Universitäts- und Poliklinik für Augenheilkunde Halle (Saale), Halle (Saale), Deutschland
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Cosentino G, Comi S, Maglionico MN, Marinò M. A case of carotid cavernous fistula mimicking Graves' orbitopathy. J Endocrinol Invest 2024; 47:255-256. [PMID: 37347382 DOI: 10.1007/s40618-023-02143-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Affiliation(s)
- G Cosentino
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Comi
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M N Maglionico
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Aldred MP, Raviskanthan S, Mortensen PW, Klucznik RP, Lee AG. Delayed Onset of a Contralateral "White-Eyed Shunt" Posterior Draining Carotid-Cavernous Fistula Following Ipsilateral "Red-Eyed Shunt". J Neuroophthalmol 2023; 43:e201-e203. [PMID: 35421869 DOI: 10.1097/wno.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Molly P Aldred
- University of Texas Health Science Center (MPA), Houston, Texas; Department of Ophthalmology (SR, PWM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Radiology (RK), Houston Methodist Hospital, Houston, TX; Departments of Ophthalmology (AGL), Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, TexasTexas A and M College of Medicine (AGL), Bryan, Texas; Department of Ophthalmology (AGL), the University of Iowa Hospitals and Clinics, Iowa City, Iowa
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6
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Al-Smadi AS, Ali R, Kappel AD, Intikhab O, Rajah GB, Luqman A. Patch Technique for Primary Treatment of Type A Carotid Cavernous Fistula: A Case Series and Technical Notes. J Neuroophthalmol 2023; 43:541-546. [PMID: 37166977 DOI: 10.1097/wno.0000000000001867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The utilization of flow diverters (FDs) in the treatment of high-flow Type A carotid cavernous fistulas (CCFs) has been described before mainly as an adjunct to the traditional endovascular techniques and rarely as a stand-alone treatment. In this study, we retrospectively evaluated our experience with FDs as the solo nonadjunctive treatment of Type A CCF with severe cortical venous reflux (CVR). METHODS A retrospective review was performed of patients with Type A CCFs who were treated using FDs' patch technique (PT). Patients' demographics, clinical data, and preoperative and postoperative ocular examination were recorded. The procedure technique, pipeline embolization device (PED) diameters, and immediate and late procedure outcomes were described. RESULTS Three patients were included in this case series. All patients had history of trauma and presented with decreased visual acuity, cranial nerve II deficit, limited extraocular muscles' movement, and increased intraocular pressure (IOP). Diagnostic angiography was performed, which confirmed high-flow Type A CCF. Endovascular treatment was performed through distal radial access in 2 patients and femoral access in 1 patient by deploying 4 sequentially enlarging PEDs with immediate resolution of the ocular symptoms. Follow-up angiography confirmed complete resolution of CCF in 2 patients. One patient was lost to follow-up; however, angiogram at 4 months demonstrated residual small CCF with significant improvement from postprocedure angiogram. CONCLUSIONS The patch technique using sequentially enlarging FDs is a reasonable alternative solo technique for the treatment of direct CCF symptoms and results in immediate resolution of CVR while preserving the cavernous sinus anatomy.
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Affiliation(s)
- Anas S Al-Smadi
- Department of Neuroradiology (ASA-S, OI), The University of Chicago, Chicago, Illinois; Departments of Radiology (RA) and Neurosurgery (ADK, GBR, AL), School of Medicine, Wayne State University, Detroit, Michigan; and Department of Neurosurgery (GBR), Munson Medical Center, Traverse City, Michigan
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Touitou V, Shor N, Mainguy A, Touhami S. When the Retina Reflects the Brain: An Unusual Presentation of a Carotid-Cavernous Fistula. J Neuroophthalmol 2023; 43:e197-e198. [PMID: 35234691 DOI: 10.1097/wno.0000000000001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Valérie Touitou
- Departments of Ophthalmology (VT, AM, ST), and Neuro-Radiology (NS), Pitié Salpêtrière University Hospital, Sorbonne Université, Paris, France
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Jogimahanti AV, Raviskanthan S, Mortensen PW, Klucznik RP, Lee AG. Spontaneous Resolution of Carotid-Cavernous Fistula Following Angiogram. J Neuroophthalmol 2023; 43:e199-e200. [PMID: 35483075 DOI: 10.1097/wno.0000000000001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Arjun V Jogimahanti
- University of Texas Medical School at Houston (AVJ), Houston, Texas; Department of Ophthalmology (SR, PWM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Radiology (RK, AGL), Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology (AGL), Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, TexasTexas A and M College of Medicine (AGL), Bryan, Texas ; andDepartment of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa (AGL)
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Zainol N, Raman P, Devi-S P, Mohd Khalid KH. RARE PRESENTATION OF BILATERAL CAROTID-CAVERNOUS FISTULA AS SUPRACHOROIDAL HEMORRHAGE DURING CATARACT SURGERY. Retin Cases Brief Rep 2023; 17:362-364. [PMID: 34381008 DOI: 10.1097/icb.0000000000001186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report a rare case of suprachoroidal hemorrhage during phacoemulsification in a patient with bilateral carotid-cavernous fistula. METHOD Case report. RESULT A 76-year-old woman with underlying hypertension presented left eye poor vision due to an underlying dense cataract. Her initial preoperative assessment was uneventful, and she underwent phacoemulsification. During epinucleus removal, there was sudden, unexpected anterior chamber shallowing, resulting in posterior capsule rupture. While the surgeon extended the wound to facilitate epinucleus removal, there was a further decrease of red reflex, followed by hardening of the globe, indicating a suprachoroidal hemorrhage. The corneal wound was opposed swiftly without an intraocular lens. Further evaluation after that revealed the patient had a chronic headache for several years, and ocular examination showed bilateral esophoria. A computed tomography demonstrated features suggestive of bilateral carotid-cavernous fistula, which was confirmed with computed tomography angiography later. CONCLUSION Patients with carotid-cavernous fistula have elevated episcleral venous pressure and vortex venous pressure. Sudden decompression of the globe in these patients predisposes them to higher suprachoroidal hemorrhage risk, although this condition is generally rare in phacoemulsification.
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Affiliation(s)
- Nurhafis Zainol
- Department of Ophthalmology, Hospital Tampin, Negeri Sembilan Darul Khusus, Malaysia; and
| | - Puspha Raman
- Department of Ophthalmology, Hospital Tuanku Ampuan Najihah, Negeri Sembilan Darul Khusus, Malaysia
| | - Premala Devi-S
- Department of Ophthalmology, Hospital Tuanku Ampuan Najihah, Negeri Sembilan Darul Khusus, Malaysia
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Cobbs L, Sheng Y, Amanullah S, Zhang C, Brodowski C, Ramesh S. Carotid cavernous fistula masquerading as orbital inflammation on noninvasive imaging in a peripartum patient. Digit J Ophthalmol 2023; 29:31-35. [PMID: 37727469 PMCID: PMC10506617 DOI: 10.5693/djo.02.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
A carotid cavernous fistula (CCF) is a pathological connection between the internal or external carotid artery and the cavernous sinus venous system. Pregnancy has been proposed as a risk factor for spontaneous CCF, but the exact mechanism of risk is unknown. Overall, there are few published reports describing CCF in pregnancy. Study of this risk factor relationship is further complicated by potential ambiguity in diagnosing CCF, which may present as subtle, nonspecific findings on initial workup. We report a case of CCF during pregnancy in which the diagnostic process was notable for misleading, noninvasive, imaging studies.
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Affiliation(s)
- Lucy Cobbs
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Young Sheng
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah Amanullah
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cathy Zhang
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Charles Brodowski
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sathyadeepak Ramesh
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Liu L, Zhong Y, Wu B, Tang X, Yi Z, Pan C. Hemicranial postural headache as a first symptom of a spontaneous carotid cavernous fistula: A case report. Medicine (Baltimore) 2022; 101:e31088. [PMID: 36254069 PMCID: PMC9575803 DOI: 10.1097/md.0000000000031088] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Spontaneous carotid cavernous fistula (CCF) is rare, and the expression of headache caused by it can be variable. PATIENT CONCERNS A case of a man hospitalized for high-intensity hemicranial headache which was aggravated by lying down and relieved when standing or sitting. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. He gradually appeared with ophthalmoplegia, decreased visual acuity and epistaxis. DIAGNOSIS Digital subtraction angiogram (DSA) showed a pseudoaneurysm arising from the internal carotid artery (ICA) that projected anteriorly and medially into the sphenoid sinus with occluded fistula. INTERVENTIONS The pseudoaneurysm was successfully treated with covered stent. OUTCOMES The patient was then followed up clinically at the outpatient and seen in the outpatient clinic with no further episodes of nasal bleeding or new neurologic deficit. The vision loss and ophthalmoparesis were unchanged. LESSONS Hemicranial postural headache may be the first and characteristic sign of spontaneous CCF.
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Affiliation(s)
- Li Liu
- Department of Neurology, The First People’s Hospital of Huaihua of University of South China, Huaihua, PR China
- The Advanced Stroke Center of China, Huaihua, PR China
| | - Yushi Zhong
- Department of Neurology, The First People’s Hospital of Huaihua of University of South China, Huaihua, PR China
- The Advanced Stroke Center of China, Huaihua, PR China
| | - Bin Wu
- Department of Neurology, The First People’s Hospital of Huaihua of University of South China, Huaihua, PR China
- The Advanced Stroke Center of China, Huaihua, PR China
| | - Xianbi Tang
- Department of Neurology, The First People’s Hospital of Huaihua of University of South China, Huaihua, PR China
- The Advanced Stroke Center of China, Huaihua, PR China
| | - Ziwei Yi
- The Forth People’s Hospital of Huaihua, Huaihua, PR China
| | - Chuzheng Pan
- Department of Neurology, The First People’s Hospital of Huaihua of University of South China, Huaihua, PR China
- The Advanced Stroke Center of China, Huaihua, PR China
- * Correspondence: Chuzheng Pan, Department of Neurology, The First People’s Hospital of Huaihua of University of South China, Huaihua, PR China (e-mail: )
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Gandy CL, Tooley AA, Lee AYJ, Tran AQ, Oliveira C, Patsalides A, Godfrey KJ. Acute Orbital Compartment Syndrome After Coil Embolization of a Contralateral Carotid Cavernous Fistula. J Neuroophthalmol 2022; 42:e398-e400. [PMID: 33449493 DOI: 10.1097/wno.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Christiana L Gandy
- Department of Ophthalmology (CLG, AAT, AQT, CO, KJG), Weill Cornell Medical College, New York, New York; Weill Cornell Medical College (AYJL), New York, New York; and Departments of Neurological Surgery (AP) and Radiology (AP), Weill Cornell Medical College, New York, New York
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Gupta V, Luthra S, Puthalath AS, Chauhan U. Undiagnosed malignant hypertension presenting as a direct spontaneous carotid-cavernous fistula with complete loss of vision and hyphaema. BMJ Case Rep 2022; 15:e246243. [PMID: 35210224 PMCID: PMC8883199 DOI: 10.1136/bcr-2021-246243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vinita Gupta
- Department of Ophthalmology, AIIMS Rishikesh, Rishikesh, India
| | - Saurabh Luthra
- Department of Ophthalmology, Drishti Eye Institute, Dehradun, India
| | | | - Udit Chauhan
- Department of Ophthalmology, AIIMS Rishikesh, Rishikesh, India
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Hoang TT, Nguyen CN, Nguyen AQ, Nguyen HL, Subramanian PS, Pham VT. Contralateral Ocular Manifestations of a Carotid Cavernous Fistula Associated With Primitive Persistent Trigeminal Artery. J Neuroophthalmol 2021; 41:e803-e805. [PMID: 33449487 DOI: 10.1097/wno.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tung Thanh Hoang
- Ophthalmology Department (TTH, VTP), Hanoi Medical University, Vietnam; Ophthalmology Unit (TTH), Hanoi Medical University Hospital, Vietnam; Save Sight Institute (TTH), the University of Sydney School of Medicine, Australia ; Radiology Department (CNN), Hanoi Medical University Hospital, Vietnam; Oculoplastic and Cosmesis Surgery Department (AQN), Vietnam National Eye Hospital; Cardiology Center (HLN), Hanoi Medical University Hospital, Vietnam; and Ophthalmology Department (PSS), University of Colorado School of Medicine
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jozef Č. Carotid-cavernous fistula from the perspective of an ophthalmologist A Review. Cesk Slov Oftalmol 2020; 1:1-8. [PMID: 33086846 DOI: 10.31348/2020/8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Carotid-cavernous fistula (CCF) is an abnormal communication - vascular connection between arteries and veins in the cavernous sinus. Classification according to etiology is traumatic vs spontaneous. According to blood flow rate per high flow vs low flow fistula. According to anatomy of direct vs indirect: Direct (direct) CCF arises through direct communication between the internal carotid artery (ICA) and the cavernous sinus. Indirect CCF originates through indirect communication through the meningeal branches of ICA, external carotid artery and cavernous sinus (not directly with ICA) and Barrow type A, B, C, D division. Patients subjective complaints depend on the type of CCF. Most often it is pulsating tinnitus, synchronous with blood pulse. Typical findings include protrusion and pulsation of the eyeball, corkscrew vessels - arterialization of conjunctival and episleral vessels, increased intraocular pressure, not responding to local antiglaucomatous therapy, keratopathy a lagophthalmo, corneal ulcers. In the later untreated stages of CCF, secondary, venous stasis or central retinal vein occlusion can occur. Diagnostic procedures include B-scan and color Doppler ultrasonography, digital ophthamodynamometry, computer tomography, nuclear magnetic resonance and digital subtraction angiography. CCF can simulate orbitopathy, conjunctivitis symptoms, carotid occlusion, scleritis or cavernous sinus thrombosis. The ophthalmologist should recognize and indicate the necessary examinations in a timely manner. The therapy is ophthalmological, neuroradiological, sterotactic, surgical and conservative.
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Goin P, Charpentier H, Delattre M, Delbosc B, Gauthier AS. [Acute angle closure attack secondary to a cavernous sinus dural fistula]. J Fr Ophtalmol 2020; 43:e393-e396. [PMID: 33071006 DOI: 10.1016/j.jfo.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- P Goin
- CHU de Besançon, Besançon, France.
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Ekeh L, Dermarkarian CR, Foroozan R, Bhatti MT. A shotgun wedding. Surv Ophthalmol 2020; 66:668-673. [PMID: 32628947 DOI: 10.1016/j.survophthal.2020.06.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
A 69-year-old woman developed a carotid-cavernous fistula (CCF) after firing a shotgun. Initially, the patient had mild visual symptoms, but later on developed prominent features of CCF including chemosis, proptosis, ophthalmoparesis and conjunctival injection . The fistula was embolized via an intravascular coiling procedure. We are unaware of another patient who developed a CCF due to blunt force from shotgun use.
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Affiliation(s)
- Leroy Ekeh
- Cullen Eye Institute. Baylor College of Medicine. Houston, Texas
| | | | - Rod Foroozan
- Cullen Eye Institute. Baylor College of Medicine. Houston, Texas.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bouladi M, Bouraoui R, Zerei N, Dhouib N, Limaiem R, Mghaieth F, El Matri L. Association of carotido-cavernous fistula and controlateral optic neuropathy secondary to cranial trauma. Tunis Med 2019; 97:145-148. [PMID: 31535707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE to report a case of a woman who had a severe cranial trauma complicated by two ophalmologic potentially cecitating complications: right carotido-cavernous fistula and left traumatic optic neuropathy. OBSERVATION A 56 years-old woman, without any medical history, referred, one month after fall from a height of 3 meters, for right exophthalmos. Ophthalmic examination of the right eye completed by retinal angiography suspected carotid-cavernous fistula which was confirmed by angio-MRI. In the left eye, the visual acuity was decreased to no light perception and fundus examination showed optic nerve head palor secondary to traumatic optic neuropathy. Arterial embolization was performed and allowed closing of the fistula. CONCLUSION Optic neuropathy and carotido-cavernous fistula are two severe complications that can occur simultaneously in the same patient. The prognosis of the optic neuropathy may be compromised, and the treatment of carotido-cavernous fistula benefited from progress in interventional neuro-radiology.
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Han LS, Stack R. Chronic red eye-think outside the eye. N Z Med J 2018; 131:41-44. [PMID: 30496166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Louis S Han
- Ophthalmology Registrar, Southern District Health Board, Dunedin
| | - Rebecca Stack
- Ophthalmologist, Canterbury District Health Board, Christchurch
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Liu LX, Lim J, Zhang CW, Lin S, Wu C, Wang T, Xie XD, Zhou LX, Wang CH. Application of the Willis Covered Stent in the Treatment of Carotid-Cavernous Fistula: A Single-Center Experience. World Neurosurg 2018; 122:e390-e398. [PMID: 30352308 DOI: 10.1016/j.wneu.2018.10.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of the present study was to describe our single-institutional experience of treating direct carotid-cavernous fistulas (DCCFs) with Willis covered stents (WCSs). METHODS Of a total of 31 DCCFs, 10 were treated with WCSs (Microport, Shanghai, China) at West China Hospital from January 2015 to December 2016. The indications for treatment, perioperative findings, and postoperative and follow-up results were collected and analyzed. RESULTS All 10 patients had successful deployment of WCSs. Complete exclusion of the fistula was achieved in 6 patients immediately after deployment of 1 stent. Endoleak was observed in 4 patients (patients 2, 4, 5, and 9). Thus, repeat dilation of the stent with greater pressure was performed, which resolved the endoleak in 2 patients (patients 2 and 9). The endoleak of the other 2 patients persisted after repeat dilation of the balloon. Hence, a second stent was deployed in these 2 patients (patients 4 and 5), which eliminated the endoleak in patient 4. However, patient 5 continued to have a minimal endoleak. Nine patients had fistulas successfully occluded by WCSs during the follow-up period. One patient experienced recurrence of a DCCF at the 10-day follow-up point. We chose coil embolization to address this DCCF. No stenosis of the internal carotid artery or DCCF recurrence, except that in the abovementioned patient, was observed. CONCLUSIONS WCS was proved to be an alternative treatment method for complex DCCFs through reconstruction and preservation of the internal carotid artery. Our study also confirmed the safety, efficacy, and midterm durability of WCSs for complex DCCFs without any serious delayed complications.
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Affiliation(s)
- Lun-Xin Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Jaims Lim
- Department of Neurological Surgery, University of Buffalo, Buffalo, New York, USA
| | - Chang-Wei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Sen Lin
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Cong Wu
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Ting Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Xiao-Dong Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Liang-Xue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Chao-Hua Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China.
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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: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Lee WJ, Hou CY. Female with Diplopia. J Emerg Med 2017; 52:361-363. [PMID: 27717587 DOI: 10.1016/j.jemermed.2016.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Wei-Jing Lee
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Cheng-Yu Hou
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
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Szabó I, Zag L, Csontos A, Takács IF, Szikora I. Patient with a spontaneously evolving carotid cavernous fistula in the emergency department. Ideggyogy Sz 2017; 70:63-67. [PMID: 29870194 DOI: 10.18071/isz.70.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background - Approximately 2% of patients admitted to the emergency department present with headache, which is often associated with vomiting, ocular pain, and earache. In rare cases, the presence of an abnormal communication between a cavernous sinus and the carotid arterial system that creates a carotid cavernous fistula is the main cause of these symptoms. Case presentation - A 32-year-old woman presented at the emergency department with unilateral headache associated with earache on the same side, and pulsating tinnitus. On examination, we observed unusual appearance of our patient (small stature, unusually visible skin, lobeless ears). In the first 5 hours of our observation no neurological symptoms had been present, but after a severe vomiting, exophthalmos, subconjunctival suffusion and moderate ptosis developed. First, regarding the initial general symptoms, otorhinolaryngologist assessed the patient, and did not find any abnormality. Further, we ordered computed tomography and consulted a neurologist. Despite of the negative results we continued the observation because her symptoms did not improve. After appearance of neurological symp-toms, carotid cavernous fistula was suspected. Magnetic resonance imaging and ophthalmologist consultation verified the diagnosis. For therapy, she was transferred to interventional neuroradiology. Because of the unusual appearance and carotic cavernous fistula, we ordered genetic examination. This indicated the presence of Ehlers-Danlos syndrome type IV in the background. The first major manifestation of the syndrome was observed at our department. Conclusions - Carotid cavernous fistula is an uncommon diagnosis in the emergency department; however, the early recognition of symptoms and early treatment can prevent further consequences of this potentially severe condition.
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Affiliation(s)
- István Szabó
- Department of Emergency Medicine, Bács-Kiskun County Hospital and Teaching Hospital of University of Szeged, Kecskemét
| | - Levente Zag
- Department of Emergency Medicine, Bács-Kiskun County Hospital and Teaching Hospital of University of Szeged, Kecskemét
| | - Amarilla Csontos
- Department of Emergency Medicine, Bács-Kiskun County Hospital and Teaching Hospital of University of Szeged, Kecskemét
| | - Irma F Takács
- Department of Emergency Medicine, Bács-Kiskun County Hospital and Teaching Hospital of University of Szeged, Kecskemét
| | - István Szikora
- Department of Neurointerventions, National Institute of Clinical Neurosciences, Budapest
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Mousa A, Bernheim J, Lyon R, Dayal R, Hollenbeck S, Henderson P, Clair D, Kent KC, Faries PL. Postcarotid Endarterectomy Pseudoaneurysm Treated with Combined Stent Graft and Coil Embolization. Vasc Endovascular Surg 2016; 39:191-4. [PMID: 15806281 DOI: 10.1177/153857440503900209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pseudoaneurysm formation is a rare complication following carotid endarterectomy (CEA); however, its occurrence is associated with significant risk of morbidity. The patient in this report presented 2 years following CEA with headache and lateral neck mass. The diagnosis of a 3.5 x 3.0 cm carotid artery bifurcation pseudoaneurysm was made by using magnetic resonance angiography (MRA). Endovascular exclusion of the aneurysm was accomplished with coil embolization of the external carotid artery followed by deployment of a 7 x 50 mm wall stent graft into the common carotid artery-internal carotid artery (CCA-ICA). The patient's symptoms improved and at 6-months postexclusion, duplex ultrasound demonstrated a significant reduction in pseudoaneurysm size. This case highlights the feasibility and safety of using endovascular techniques in the treatment of post-CEA pseudoaneurysm.
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Affiliation(s)
- Albeir Mousa
- New York Presbyterian Hospital, Cornell University, Weill Medical School and Columbia University, College of Physicians and Surgeons, 525 E. 68th., New York, NY 10021, USA
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27
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Ghodasra DH, Katowitz JA, Liu GT, Binenbaum G. Indirect internal carotid-cavernous fistula in infancy. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e11-3. [PMID: 25751239 DOI: 10.3928/01913913-20150303-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/29/2015] [Indexed: 11/20/2022]
Abstract
A 4-month-old male infant with proptosis and episcleral injection initially thought to have orbital inflammation was found to have an indirect carotid-cavernous sinus fistula. He was treated conservatively without worsening of symptoms. The authors report the first case of indirect carotid-cavernous sinus fistula in an infant originating from the internal carotid artery.
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Oumellal J, Bekaert O, Gallas S, Leguerinel C, Palfi S, Derkaoui F, El Fatemi N, Gana R, Elmaquili MR, Elabbadi N. Fistules carotido-caverneuses post-traumatiques à propos d’un cas et revue de la littérature. Pan Afr Med J 2015; 21:290. [PMID: 26587139 PMCID: PMC4634034 DOI: 10.11604/pamj.2015.21.290.6210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 06/16/2015] [Indexed: 11/24/2022] Open
Abstract
Les auteurs rapportent une observation clinique d'une fistule carotidocaverneuse survenue à la suite d'un traumatisme craniofaciale grave. Une exophtalmie unilatérale pulsatile et asymétrie des 2 sinus caverneux au scanner ont permis de suspecter le diagnostic. Une artériographie a permis de confirmer ce diagnostic, avec embolisation couronnée de succès chez ce malade, mais l’évolution est défavorable sur le plan neurologique avec apparition d'une HTIC réfractaire au traitement médical maximal. La fistule carotido-caverneuse est une complication rare mais grave pouvant engager le pronostic fonctionnel (cécité) et vital (hémorragie méningée et intracérébrale).L'artériographie et l'embolisation en un seul temps ont considérablement amélioré le pronostic.
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Affiliation(s)
- Jamal Oumellal
- Service de Neurochirurgie et Neuroradiologie Interventionnelle, Hôpital Henri Mondor, Créteil, France ; Service de Neurochirurgie, Hôpital Avicenne, Rabat, Maroc
| | - Olivier Bekaert
- Service de Neurochirurgie et Neuroradiologie Interventionnelle, Hôpital Henri Mondor, Créteil, France
| | - Sophie Gallas
- Service de Neurochirurgie et Neuroradiologie Interventionnelle, Hôpital Henri Mondor, Créteil, France
| | - Caroline Leguerinel
- Service de Neurochirurgie et Neuroradiologie Interventionnelle, Hôpital Henri Mondor, Créteil, France
| | - Stéphane Palfi
- Service de Neurochirurgie et Neuroradiologie Interventionnelle, Hôpital Henri Mondor, Créteil, France
| | - Fahd Derkaoui
- Service de Neurochirurgie, Hôpital Avicenne, Rabat, Maroc
| | | | - Rachid Gana
- Service de Neurochirurgie, Hôpital Avicenne, Rabat, Maroc
| | | | - Najia Elabbadi
- Service de Neurochirurgie, Hôpital Avicenne, Rabat, Maroc
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Nibrass C, Ahmed C, Lina J, Mejda B, Leila EM. [Exophthalmos revealing a carotid-cavernous fistula: about 2 cases]. Tunis Med 2014; 92:512-513. [PMID: 25775298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Bilbin-Bukowska A, Stepień A, Brzozowski K, Piasecki P, Skrobowska E. [Diagnostic and therapeutic problems of bilateral carotid-cavernous sinus fistula]. Pol Merkur Lekarski 2014; 36:345-347. [PMID: 24964514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Carotid-cavernous sinus fistula is an abnormal connection between the internal carotid artery, external one or their meningeal branches and the sinus cavernous. It can be the spontaneous or post-traumatic pathology. The main clinical syndrome is Dandy's triad: pulsating exophthalmia, chemosis, bruit in the region of orbit. These syndromes appear in the case of the most frequent direct carotid-cavernous sinus fistula (type-A in Barrow classification). Indirect carotid-cavernous sinus fistulas are significantly more uncommon and the symptoms can be atypical and less intensive. It makes difficulties in establishing the right diagnosis. The case report concerns the occurrence of bilateral carotid-cavernous sinus fistula, supplying by numerous arteries, with atypical clinical picture.
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Tan ACS, Farooqui S, Li X, Tan YL, Cullen J, Lim W, Leng SL, Looi A, Tow S. Ocular manifestations and the clinical course of carotid cavernous sinus fistulas in Asian patients. Orbit 2014; 33:45-51. [PMID: 24195725 DOI: 10.3109/01676830.2013.851253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To study the clinical course with regard to both the angiographic and visual outcomes of carotid cavernous fistulas (CCFs). BACKGROUND Carotid cavernous sinus fistulas (CCFs) are conditions which often present with ocular signs and symptoms. The clinical presentation of CCFs is varied according to the anatomy, haemodynamics and size of the CCF. CCFs causing significant symptoms or vision loss should be treated with embolization. METHODS This is a retrospective review of the medical records of all CCF cases seen in the Singapore National Eye Centre from September 2002 to December 2011. RESULTS 45 patients who had confirmed CCF on conventional cerebral angiography were included. Anterior draining CCFs presented with orbital congestion while posterior draining CCFs presented with pain, diplopia and cranial nerve palsies. Mild residual symptoms were still present in 85% of treated direct CCFs despite complete angiographic closure however 52% of treated dural CCFs had complete resolution of symptoms despite only half of those achieving angiographic closure. Treated and untreated dural CCFs had similar outcomes (87% versus 76% recovered or improved (p > 0.05)). Poor outcomes can result from residual diplopia or vision loss from complications of the CCF itself (e.g. compressive optic neuropathy, glaucoma, retinopathy) or complications from CCF embolization treatment (e.g. central retinal artery occlusion). CONCLUSION Presenting symptoms and signs are related to the angiographic drainage of CCFs. Angiographic outcomes after embolization treatment may not always correlate with clinical outcomes.
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Yamamoto M, Oishi H, Arai H. [Endovascular treatment for traumatic carotid-cavernous fistula]. No Shinkei Geka 2013; 41:1105-1110. [PMID: 24317888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
OBJECTIVES To present the clinical features, determine the causes and evaluate the prognosis of orbital apex syndrome in patients of Songklanagarind Hospital. METHODS A retrospective review was conducted of patients diagnosed with orbital apex syndrome between January 1, 2002 and December 31, 2008. RESULTS In our series, the major cause of orbital apex syndrome was carotid-cavernous sinus fistula, for which 30 patients were diagnosed. After excluding those patients whose condition was caused by carotid-cavernous sinus fistula, 50 patients (58 eyes) were analyzed. The mean age of the patients was 47.60 ± 18.88 years (27 male patients and 23 female patients). The most common presenting symptom was blurred vision (86%). The median duration of the presenting symptom was 37.5 d. Of the 50 patients the most frequent aetiology of orbital apex syndrome was neoplasia (48%), of which lymphoma was the most common in this group. After treatment, the vision of 19.4% of the patients improved and proptosis improved by 68.4%. CONCLUSIONS The most common presenting symptom of orbital apex syndrome was blurred vision. The most frequent aetiology of orbital apex syndrome of all patients was carotid-cavernous sinus fistula, while the next most frequent was neoplasm, of which lymphoma was the most common in this group. Patients had a good outlook, after treatment directed at the cause, with a modest improvement in vision and exophthalmos in more than half of patients.
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Affiliation(s)
- Orapan Aryasit
- Faculty of Medicine, Department of Ophthalmology, Prince of Songkla University, Hat Yai, 90112, Thailand.
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Kim JW, Kim SJ, Kim MR. Traumatic carotid-cavernous sinus fistula accompanying abducens nerve (VI) palsy in blowout fractures: missed diagnosis of ‘white-eyed shunt’. Int J Oral Maxillofac Surg 2013; 42:470-3. [PMID: 23415244 DOI: 10.1016/j.ijom.2013.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 12/14/2012] [Accepted: 01/14/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University, Seoul, Republic of Korea
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Ikeda G, Kato N, Watanabe D, Ogata A, Kasuya H, Yamazaki T, Sugita K, Sonobe M. [A case of non-traumatic direct carotid-cavernous fistula presenting with cerebral infarction]. No Shinkei Geka 2012; 40:785-792. [PMID: 22915700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 76-year-old female presented with a rare case of cerebral infarction as a complication of non-traumatic direct carotid-cavernous fistula (CCF). She had left hemiparesis and magnetic resonance imaging revealed cerebral infarction in the right watershed area. Angiography showed a right high-flow direct CCF with total blood steal. Preoperative 123I-IMP SPECT revealed a hypoperfusion area in the region of the right anterior cerebral artery and right middle cerebral artery. In addition, she had double vision caused by abducens nerve palsy. Transarterial embolization of the fistula with endovascular trapping using detachable coils achieved complete obliteration of the right internal carotid artery and adequate flow reduction of the direct CCF. Postoperative angiography showed good filling of the collateral-flow via the posterior communicating artery without retrograde blood steal to the CCF. Her symptoms improved gradually after the procedure. Diffusion-weighted MR imaging obtained 8 days after the procedure revealed a few high signals in the right hemisphere, suggesting cerebral infarctions, but she presented no symptom. Postoperative 123 I-IMP SPECT showed an improvement of cerebral perfusion in the region of the right MCA posterior and left MCA. Cerebral ischemia caused by direct CCF is rare, and there are only a few reports of non-traumatic direct CCF presenting with cerebral infarction. This very rare case suggests that endovascular trapping is safe and useful as a treatment for direct CCF, especially in the case of an elderly patient with total blood steal.
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Affiliation(s)
- Go Ikeda
- Department of Neurosurgery, National Hospital Organization, Japan
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Barut BO, Tascilar N, Aciman E, Acikgoz M, Ekem S. Carotid cavernous fistula with bilateral thalamic infarct. J PAK MED ASSOC 2012; 62:726-728. [PMID: 23866525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Carotid cavernous fistula (CCF) is an abnormal communication between cavernous sinus and carotid arterial system. Diagnosis depends on clinical manifestations and MRI findings and angiography. Clinical presentation of CCFs is characterized with chemosis, orbital bruit and pulsatile proptosis. Cranial nerve dysfunction and orbital pain might accompany these symptoms. Although spontaneous remission might occur, sometimes CCF might develop life threatening complications. Here in this case we presented a patient with CCF who afterwards developed bilateral thalamic infarct. Cerebral ischemia in CCF is a rare complication and CCF together with bilateral thalamic infarct has not been reported before.
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Affiliation(s)
- Banu Ozen Barut
- Zonguldak Karaelmas University, Faculty of Medicine, Department of Neurology, Zonguldak, Turkey.
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Pang PF, Jiang ZB, Zhou B, Li ZR, Huang MS, Zhu KS, Guan SH, Chen JW, Shan H. [Diagnosis and treatment of carotid-cavernous fistula: analysis of 28 patients]. Zhonghua Yi Xue Za Zhi 2012; 92:1458-1462. [PMID: 22944030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of endovascular treatment for different types of carotid cavernous fistula (CCF) via the approach of internal carotid artery (ICA) or inferior petrosal sinus (IPS). METHODS From April 2005 to June 2010, 28 CCF patients underwent endovascular treatment at our institution. There were 13 males and 15 females with a mean age of 39 years (range: 21 - 71). According to the Barrow's classification, they were classified into type A (n = 21), type B (n = 2) and type D (n = 5). Patients of type A underwent detachable balloon embolization of ipsilateral cavernous sinus or stent-graft placement via the ICA approach. Patients of types B and D received detachable coil plus n-BCA (n-butyl-2-cyanoacrylate) embolization of ipsilateral cavernous sinus via the IPS approach. The technical results, complications and therapeutic outcomes were reviewed. RESULTS Detachable balloons (number: 1 - 4) were used in 16 patients of type A. Angiography at immediate postembolization showed a complete occlusion of fistula in 15 patients and a small residual fistula (< 20%) in 1 patient. Five patients of type A received stent-graft placement. One stent was placed in 4 patients and 2 stents in 1 patient. Complete fistula closures with preserved ICA were documented on immediate angiogram in 3 patients whereas a large residual flow (> 50%) persisted in 1. The fistula was completely occluded after 3 detachable balloons were deployed in affected cavernous sinus through a gap between stent and vascular wall. Both fistula and ICA were occluded in 1 patient after stenting. No cerebral infarction was observed due to the adequate collateral blood flow from contralateral ICA. Complete closures of affected cavernous sinus were achieved in 6 patients of types B and D while residual flow (< 50%) persisted in 1. The number of detachable coils for each embolization ranged from 3 to 8 (mean: 6.0). The volume of n-BCA mixture varied from 1.0 to 2.1 ml (mean: 1.3). The mean duration of n-BCA injection was 65 s (range: 45 - 90). Clinical symptoms were completely relieved in 26 patients. During the mean follow-up period of 30 months (range: 12 - 60), no recurrence of clinical symptoms was observed. No thrombosis or stenosis was found in the lumina of stents. CONCLUSION Detachable balloon embolization is the preferential treatment for direct CCF. Detachable coil plus n-BCA embolization of cavernous sinus via the IPS approach is an efficient and safe treatment for indirect CCF.
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Affiliation(s)
- Peng-fei Pang
- Department of Radiology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
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Takai Y, Tanito M, Miyazaki T, Sugimoto K, Akiyama Y, Ohira A. Ocular pulse amplitude measured by PASCAL dynamic contour tonometry in patients with a cavernous sinus dural arteriovenous fistula. Acta Ophthalmol 2012; 90:e333-5. [PMID: 21951977 DOI: 10.1111/j.1755-3768.2011.02263.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Masaya-Anon P. Isolated oculomotor nerve palsy in a white-eyed patient with dural carotid-cavernous sinus fistulas: a case report. J Med Assoc Thai 2012; 95 Suppl 4:S143-S146. [PMID: 22696867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The study reported a woman with dural carotid-cavernous sinus fistulas (CCFs) who presented with a unilateral white-eyed appearance, and painful oculomotor nerve palsy with pupillary involvement. After cerebral angiography, which revealed posterior drainage of the fistulas, the dural CCFs closed, the oculomotor nerve palsy subsided spontaneously and no recurrence occurred throughout the 2-year follow-up. Dural CCFs should be kept in mind when patients present with painful oculomotor nerve palsy. Moreover, cerebral angiography remains the standard diagnostic method and fistulas may close spontaneously following this procedure.
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Santos-Franco JA, Lee A, Nava-Salgado G, Zenteno M, Gómez-Villegas T, Dávila-Romero JC. [Traumatic arteriovenous pial fistula masquerading as a carotid-cavernous fistula: an uncommon disorder with an unusual presentation]. GAC MED MEX 2012; 148:76-80. [PMID: 22367311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Traumatic intracranial pial arteriovenous fistulae are infrequent lesions. Their cardinal signs have been related to mass effect and hemorrhage, but their clinical manifestations due to venous retrograde flow into ophthalmic veins has never been described. This phenomenon is usually seen in dural arteriovenous fistula draining to the cavernous sinus or carotid-cavernous sinus fistula.A traumatic intracranial pial arteriovenous fistula arising from the supraclinoid internal carotid artery in a young patient was revealed by aggressive behavior and ophthalmologic manifestations. The endovascular management included the use of coils, stent, and ethylene-vinyl alcohol with transient balloon occlusion of the parent vessel.
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Affiliation(s)
- Jorge Arturo Santos-Franco
- Servicio de Neurocirugía, Hospital de Especialidades del Centro Médico Nacional, Instituto Mexicano del Seguro Social, México.
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Hatabe N, Chikama T, Sonod KH, Ishihara H, Suzuki M. [A case of anterior condylar confluence dural arteriovenous fistula with initial onset of ocular symptoms]. Nippon Ganka Gakkai Zasshi 2011; 115:905-909. [PMID: 22117323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To report a case of anterior condylar confluence dural arteriovenous fistula (ACC dAVF) with initial onset of ocular symptoms. CASE A 63-year-old man with conjunctival injection and eyelid edema with a suspected carotid cavernous fistula (CCF) was referred to our department by the department of neurosurgery of our hospital. On his first visit, his left eye showed marked conjunctival injection and eyelid edema OS. Those findings were consistent with CCF, however, three-dimensional angiography indicated a diagnosis of ACC dAVF. His ocular symptoms improved immediately following transvenous embolization with coils at the shunting point. CONCLUSION Although most cases of ACC dAVF start with tinnitus, this case showed ocular abnormalities without tinnitus as the initial symptoms.
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Affiliation(s)
- Nanami Hatabe
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube-shi, Yamaguchi-ken 755-8505, Japan.
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Chan HW, Haliasos N, Derakhshani S, Vindlacheruvu R, Chawda S. Delayed caroticocavernous fistula after stent-assisted coil embolization of intracavernous carotid aneurysm: should we manage conservatively? Acta Neurochir (Wien) 2011; 153:1291-5. [PMID: 21347579 DOI: 10.1007/s00701-011-0968-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 02/07/2011] [Indexed: 11/24/2022]
Abstract
Constructive endovascular techniques remain the mainstay for the treatment of cavernous carotid aneurysms due to their efficacy. However, they do harbor risks of complications, such as thromboembolic events, arterial injuries, and vessel occlusions. A 58-year-old lady presented with delayed caroticocavernous fistula (CCF) 1 month after stent-assisted coil embolization of a cavernous carotid aneurysm (CCA). Following this, her caroticocavernous fistula resolved spontaneously with no further intervention. Our case demonstrates a unique presentation of a CCF as a delayed complication of stent-assisted coil embolization of CCA and the spontaneous resolution of the CCF. Symptomatic CCFs are commonly treated as an emergency in many institutions and the question arises as to whether we should adopt a conservative policy in the light of this case report.
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Affiliation(s)
- Huan Wee Chan
- Queens Hospital, Rom Valley Way, Romford, RM7 0AG, UK.
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Aldea S, Guedin P, Roccatagliata L, Boulin A, Auliac S, Dupuy M, Cerf C, Gaillard S, Rodesch G. Controlateral cavernous syndrome, brainstem congestion and posterior fossa venous thrombosis with cerebellar hematoma related to a ruptured intracavernous carotid artery aneurysm. Acta Neurochir (Wien) 2011; 153:1297-302. [PMID: 21380852 DOI: 10.1007/s00701-011-0982-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 02/17/2011] [Indexed: 11/25/2022]
Abstract
Intracavernous carotid artery aneurysms (ICCAs) are rarely associated with life-threatening complications. We describe a 55-year-old woman who, after the rupture of an intracavernous carotid artery aneurysm, presented with a contralateral cavernous sinus syndrome and severe posterior fossa and spinal cord symptoms. Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a "locked-in" state. The patient fully recovered with anticoagulation therapy. Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications related to venous thrombosis.
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Affiliation(s)
- Sorin Aldea
- Department of Neurosurgery, Hopital Foch, Suresnes, France.
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Abstract
Here we report a 79-year-old woman who presented with a 7-day history of headache, nausea, vomiting, and was found to have proptosis and ptosis. Laboratory findings showed hyponatremia, hypocortisolism, secondary hypothyroidism and low follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. CT angiography (CTA) showed a vascular lesion in sella causing a mass affect on the pituitary gland which proved to be a carotid cavernous fistula (CCF) by conventional angiography. The lesion was subsequently treated with coil placement and patient's hyponatremia was successfully treated with corticosteroid and thyroid hormone replacement. Though rare, CCF should be considered in the differential diagnosis of sellar lesions. Also, in patients with CCF hyponatremia, hypotension or signs of hypothyroidism should warrant a work-up for pituitary function.
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Fernández N, Murias E, Vega P, Sainz A, Meilán A. [Angioplasty confirmation of the spontaneous resolution of two low-flow carotid-cavernous fistulas]. Neurologia 2010; 25:333-336. [PMID: 20643045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Zemba M, Enache V, Manole C, Cucu B, Furedi G, Halmaci V. [The secret of red eyes]. Oftalmologia 2010; 54:78-83. [PMID: 21137195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
"Red eye" is a sign and the same time a symptom frequently met in the ophthalmological practice. The "red eye" is not always the clinical manifestation of a common conjunctivitis. We will present a case report of a patient who accused conjunctival hyperemia, lacrimation, foreign--body sensation; she was also describing recurrent conjunctivitis for the past year. After an detailed ophthalmologic examination and interdisciplinary consultations. She was diagnosed with Basedow Disease and paraselar meningioma with invasion in the pterigoid fossa. The authors are suggesting that there is an indirect left carotid - cavernous fistula.
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Affiliation(s)
- M Zemba
- Spitalul Universitar de Urgenţă Militar Central "Dr. Carol Davila" Bucureşti
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Pons Y, Ukkola-Pons E, Hunkemöller I, Raynal M, Lepage P, Blondet E, Rigal-Sastourne JC, Héran F, Kossowski M. [Post-traumatic carotid cavernous fistula: report of two cases]. Rev Laryngol Otol Rhinol (Bord) 2010; 131:225-228. [PMID: 21491776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The authors reported the clinical presentation and therapeutic procedure of two cases. The physician has to be aware of this diagnosis when a patient is referred for a posttraumatic exophthalmia. The medical behaviour is multidisciplinary (ENT, ophthalmologist, radiologist and neurosurgeon). The imaging of choice is the angiography but angio-MRI and angio-CT can help to confirm the diagnosis. The endovascular embolization is the treatment of choice. It presents an acceptable risk of complication and a low risk of failure. In this paper the authors report 2 posttraumatic CCF cases treated with success by endovascular embolization.
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Affiliation(s)
- Y Pons
- Hôpital d'Instruction des Armées Percy, Service d'ORL Chirurgie Cervicofaciale, 101, avenue Henri Barbusse, 92141 Clamart, France.
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Yue J, Kong W, Yang C, Zhang S, Wang Y, Chen X. [The diagnosis and treatment of traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus (a report of 6 cases)]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009; 23:843-845. [PMID: 20120865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE In order to prevent misdiagnosis and degrade death rate, we explored the early diagnosis and correct treatment methods of traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus. METHOD The clinic data of 6 cases who had traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus and were admitted in our hospital were analyzed retrospectively. Large numbers of literature about the disease were reviewed. Some early diagnosis methods and optimal treatment schemes were proposed. RESULT All patients had a history of cranium trauma and recurrent attacks nasal hemorrhage. There are two patients with a complication of sight loss in single eye. In the six cases, one case was treated with unilateral common carotid artery ligation, three cases were treated with aneurysm and internal carotid artery embolism by using sacculus proprius which is able to shedding, one case was treated with internal carotid artery embolism by using tiny circlip ring. These five patients were cured with no severe complication. One patient death of hemorrhage. His nasal cavity was tamponade repeatedly because repeat nasal hemorrhage. However, he had never treated with internal carotid artery embolism. CONCLUSION The patients who have traumatic pseudoaneurysm of internal carotid artery usually die of unmanageable hemorrhage. The patients may be cured if they could obtain an early diagnosis and correct treatment.
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Affiliation(s)
- Jianxin Yue
- Department of Otorhinolaryngology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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Park YS, Jung JY, Ahn JY, Kim DJ, Kim SH. Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery. ACTA ACUST UNITED AC 2009; 72:741-6. [PMID: 19604552 DOI: 10.1016/j.surneu.2009.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 05/04/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery. CASE DESCRIPTION We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day. CONCLUSIONS Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary.
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Affiliation(s)
- Young Seok Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
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Abstract
In this article, the neuroradiological evaluation of traumatic brain injury is reviewed. Different imaging strategies in the assessment of traumatic brain injury are initially discussed, and this is followed by a review of the imaging characteristics of both primary and secondary brain injuries. Computed tomography remains the modality of choice for the initial assessment of acute head injury because it is fast, widely available, and highly accurate in the detection of skull fractures and acute intracranial hemorrhage. Magnetic resonance imaging is recommended for patients with acute traumatic brain injury when the neurological findings are unexplained by computed tomography. Magnetic resonance imaging is also the modality of choice for the evaluation of subacute or chronic traumatic brain injury. Mild traumatic brain injury continues to be difficult to diagnose with current imaging technology. Advanced magnetic resonance techniques, such as diffusion-weighted imaging, magnetic resonance spectroscopy, and magnetization transfer imaging, can improve the identification of traumatic brain injury, especially in the case of mild traumatic brain injury. Further research is needed for other advanced imaging methods such as magnetic source imaging, single photon emission tomography, and positron emission tomography.
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MESH Headings
- Arachnoid Cysts/diagnosis
- Arachnoid Cysts/etiology
- Brain Edema/diagnosis
- Brain Edema/etiology
- Brain Infarction/diagnosis
- Brain Infarction/etiology
- Brain Injuries/complications
- Brain Injuries/diagnosis
- Carotid-Cavernous Sinus Fistula/diagnosis
- Carotid-Cavernous Sinus Fistula/etiology
- Central Nervous System Vascular Malformations/diagnosis
- Central Nervous System Vascular Malformations/etiology
- Cerebrovascular Trauma/diagnosis
- Cerebrovascular Trauma/etiology
- Diagnosis, Differential
- Diagnostic Imaging/methods
- Encephalocele/diagnosis
- Encephalocele/etiology
- Encephalomalacia/diagnosis
- Encephalomalacia/etiology
- Hematoma, Epidural, Cranial/diagnosis
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Subdural/diagnosis
- Hematoma, Subdural/etiology
- Humans
- Hydrocephalus/diagnosis
- Hydrocephalus/etiology
- Magnetic Resonance Imaging/methods
- Severity of Illness Index
- Subarachnoid Hemorrhage, Traumatic/diagnosis
- Subarachnoid Hemorrhage, Traumatic/etiology
- Subdural Effusion/diagnosis
- Subdural Effusion/etiology
- Tomography, X-Ray Computed
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Affiliation(s)
- Tuong H Le
- Department of Radiology, Brain and Spinal Cord Injury Center, San Francisco General Hospital, San Francisco, CA, USA
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