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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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Uzundede T, Kırmacı Kabakcı A, Yıldız Ö, Taşkıran Çömez A. A Troublesome Case of Indirect Carotid-Cavernous Fistula Presenting with Proptosis without Pulsation. Klin Monbl Augenheilkd 2024; 241:661-665. [PMID: 36414022 DOI: 10.1055/a-1984-1031] [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: 11/24/2022]
Affiliation(s)
- Tahsin Uzundede
- Ophthalmology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | | - Ömer Yıldız
- Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Voldřich R, Grygar J, Charvát F, Netuka D. Natural course of partially embolized carotid-cavernous fistulas. J Neuroimaging 2024; 34:376-385. [PMID: 38343141 DOI: 10.1111/jon.13192] [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] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND AND PURPOSE To present the first study analyzing the clinical and radiological course of carotid-cavernous fistulas (CCFs) following incomplete embolization. The study compares magnetic resonance angiography (MRA) to plain angiography (digital subtraction angiography [DSA]) and investigates the long-term ophthalmological impact of residual fistula. METHODS Fistulas classified as partially embolized after the last endovascular treatment were prospectively followed with DSA, MRA, and ophthalmological examination. Both direct and indirect CCFs were included. RESULTS Twenty-one CCFs were included in the study. Nine (43%) fistulas were direct and 12 (57%) were indirect. A favorable clinical outcome of modified Rankin scale ≤2 was recorded in 19 (90%) patients at the last follow-up. Postinterventional ophthalmologic examinations in 16 patients revealed no negative effects of residual fistulas; five remaining patients refused to undergo further examination. Spontaneous thrombosis and complete occlusion of the CCF were demonstrated in 90% of patients, with a mean time to occlusion of 5.7 ± 4.7 months. Fourteen (66%) patients completed the full imaging follow-up (MRA and DSA). In 21% of these cases, discrepancy between the two imaging modalities was observed-MRA failed to detect persistent fistulas identified by DSA. CONCLUSIONS The goal of CCF treatment is safe and complete embolization. However, if adequate flow reduction is achieved, both direct and indirect CCFs tend to spontaneously thrombose. Residual flow does not result in ophthalmological deterioration until the fistula is completely closed. MRA may not be sufficiently sensitive to detect residues of fistulas including cortical venous drainage. Therefore, complete CCF closure should be confirmed through DSA.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
| | - Jan Grygar
- Department of Ophthalmology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
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Rana K, Lim WY, Caltabiano C, Tong JY, Chryssidis S, Scroop R, Patel S, Selva D. Extraocular muscle enlargement and proptosis in carotid cavernous fistulas. Orbit 2024; 43:203-207. [PMID: 37772931 DOI: 10.1080/01676830.2023.2252912] [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: 05/25/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE To evaluate the prevalence and pattern of extraocular muscle enlargement and proptosis in patients with carotid cavernous fistulas (CCF). METHODS We conducted a retrospective study on patients with digital subtraction angiography (DSA) confirmed CCFs with neuroimaging (computed tomography or magnetic resonance imaging) performed prior to the DSA. The maximum extraocular muscle diameters were recorded. Extraocular muscles were considered enlarged if they were greater than two standard deviations above the normal muscle diameters. Proptosis was defined as the distance between the interzygomatic line to the anterior globe of ≥2 mm compared to the contralateral orbit or ≥21 mm. RESULTS Forty orbits from 20 patients were included. The mean age of participants was 65 ± 15 years and 13 (65%) were female. Thirteen (65%) fistulas were indirect and seven (35%) were direct. There was enlargement of at least one muscle in 11 (27.5%) orbits, and this was not correlated with the type of fistula (direct/indirect). The inferior rectus was most commonly enlarged in seven orbits (17.5%), followed by the medial rectus in five orbits (12.5%). Proptosis was found in 17 (43%) orbits and was more common ipsilateral to the fistula (58% ipsilateral group vs 19% contralateral group, p < .01). CONCLUSION Extraocular muscle enlargement was observed in over one-fourth of CCFs. When enlarged, the inferior and medial rectus muscles are most commonly involved. These findings may help clinicians and radiologists when evaluating the CT or MRI scans of patients with suspected CCFs.
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Affiliation(s)
- Khizar Rana
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
| | - Wan Yin Lim
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, USA
| | - Carmelo Caltabiano
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
| | - Jessica Y Tong
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
| | - Steve Chryssidis
- Department of Medical Imaging, Flinders Medical Centre, Bedford Park, USA
| | - Rebecca Scroop
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, USA
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, USA
| | - Dinesh Selva
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
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5
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Balodis A, Kalējs VR, Migunova K. Bilateral Low-Flow Type-D Dural Carotid-Cavernous Fistula: Diagnosis and Treatment with 3D Time-of-Flight Magnetic Resonance Angiography. Am J Case Rep 2024; 25:e942833. [PMID: 38504435 DOI: 10.12659/ajcr.942833] [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: 03/21/2024]
Abstract
BACKGROUND Carotid-cavernous fistula (CCF) is a rare, atypical vascular shunt between the carotid arterial system and the venous channels of the cavernous sinus, classified according to the shunt's anatomy, by etiology (resulting from trauma or occurring spontaneously), or by hemodynamic characteristics (such as low- or high-flow fistulas). CASE REPORT A 62-year-old female patient with poorly controlled arterial hypertension presented with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity. On magnetic resonance angiography (MRA), abnormal arterial flow along the cavernous sinuses was noted, suggestive of bilateral CCF. The diagnosis of indirect dural low-flow CCF (Barrow Type D) was later confirmed by digital subtraction angiography, with feeding arteries from intracavernous internal carotid artery branches, and meningeal branches of the external carotid artery, draining bilaterally to ophthalmic veins, the intracavernous sinus, and the inferior petrosal sinus. The patient was successfully treated with endovascular embolization. At 7-month follow-up, no residual arteriovenous shunting was detected. This case highlights the importance of non-invasive radiological methods for CCF, and presents rarely published radiological findings of bilateral Type-D dural CCFs on 3-dimensional time-of-flight MRA with post-treatment MRA follow-up. CONCLUSIONS Regardless of the patient's history of possible trauma, a patient presenting with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity should have a spontaneous bilateral CCF investigated to prevent delayed treatment. Experienced neuroradiologists are needed to accurately detect indirect CCF, since this condition often does not demonstrate classic symptoms.
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Affiliation(s)
- Arturs Balodis
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Department of Radiology, Riga Stradins University, Riga, Latvia
| | - Verners Roberts Kalējs
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
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6
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Yilmaz U. [Carotid-cavernous fistulas]. Radiologie (Heidelb) 2024; 64:182-188. [PMID: 38351202 DOI: 10.1007/s00117-024-01269-1] [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] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Carotid cavernous fistulas (CCFs) are rare but clinically significant vascular anomalies characterized by abnormal connections between the cavernous sinus and arteries. This overview presents a comprehensive analysis of anatomy, classification, clinical presentation, diagnosis, imaging, and therapy of CCFs. The cavernous sinus, a central venous structure in the brain, is of critical importance for understanding CCFs due to its proximity to key structures such as the internal carotid artery and cranial nerves. CLASSIFICATION CCFs are classified into direct and dural types, with direct fistulas typically being high-flow and dural fistulas being low-flow. The symptomatology varies greatly and can range from noises in the head, diplopia, red eye, tearing, to blurred vision and headaches. The diagnostic assessment requires a combination of detailed medical history, neurological and ophthalmological examination, and the use of imaging techniques. METHODS In imaging, computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for depicting the anatomical structures and blood vessels, while digital subtraction angiography (DSA) is considered the gold standard for accurate representation of the fistula. The treatment of CCFs is complex and depends on the type of fistula, location, and clinical condition of the patient. CONCLUSION This overview emphasizes the importance of precise diagnosis and individualized therapy to achieve optimal results and avoid complications. Ongoing developments in medical imaging and treatment techniques will continuously improve the treatment outcomes of patients with CCFs.
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Affiliation(s)
- Umut Yilmaz
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str., Gebäude 90.4, 66421, Homburg, Deutschland.
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Hsieh JT, Chia GS, Wong CP, Lim WEH, Wen DW. Off-label use of large diameter Concerto fibered coils through a 0.017 inch microcatheter for transvenous embolization of indirect carotid-cavernous fistulas: two case reports. J Med Case Rep 2024; 18:43. [PMID: 38311749 PMCID: PMC10840205 DOI: 10.1186/s13256-024-04344-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND A carotid-cavernous fistula is an abnormal communication between the arteries and veins within the cavernous sinus. While conservative management may be prudent in low risk cases, many patients require intervention and endovascular embolization has evolved as the preferred method of treatment. Embolization can be performed via either the transarterial or transvenous approach. One major challenge of the transvenous approach is the complex and variable compartmentation of the cavernous sinus, which often requires the use of low profile microcatheters to navigate and reach the fistulous point. Fibered coils are also preferred when performing transvenous embolization of carotid-cavernous fistula, as they are of higher thrombogenicity and allow for faster occlusion of the fistula. However, most low profile (0.017-inch) microcatheters are not able to deploy fibered coils based on the manufacturer's instructions. CASE PRESENTATION We present two successful cases of off-label use of Medtronic Concerto fibered coils via a 0.017-inch microcatheter during transvenous embolization of carotid-cavernous fistula in a 60-year-old and an 80-year-old Chinese female, respectively. CONCLUSION Our case series highlight the possibility of deploying large diameter (up to 10 mm) Concerto fibered coils through a low profile (0.017-inch) microcatheter in an off-label manner for transvenous embolization of indirect carotid-cavernous fistula.
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Affiliation(s)
- Justin T Hsieh
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.
| | - Ghim Song Chia
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Chen Pong Wong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Winston Eng Hoe Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - David W Wen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
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Trennheuser S, Reith W, Kühn JP, Morris LGT, Bozzato A, Naumann A, Schick B, Yilmaz U, Linxweiler M. Transorbital embolization of cavernous sinus dural arterio-venous malformations with surgical exposure and catheterization of the superior ophthalmic vein. Interv Neuroradiol 2023; 29:715-724. [PMID: 35758285 PMCID: PMC10680959 DOI: 10.1177/15910199221110967] [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] [Received: 02/25/2022] [Revised: 05/11/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Cavernous sinus dural arterio-venous malformations (dAVF) represent a pathologic connection between branches of the internal and/or external carotid artery and the cavernous sinus. Standard endovascular approaches for dAVF treatment are transvenous embolization through the inferior petrosal sinus or the facial vein and transarterial embolization. These approaches are not always successful or feasible, and alternative techniques are required. Here, we present a case series of a minimally invasive transorbital approach with surgical exposure and catheterization of the superior ophthalmic vein for transvenous fistula coiling. METHODS 14 patients with dAVFs (Barrow Type B to D) that were treated at a tertiary care medical center over a period of 13 years were included in the study. Patients with persisting dAVF associated symptoms were selected for this approach when conventional endovascular interventions were not successful or not feasible. The surgical procedure was performed under general anaesthesia. RESULTS A successful transorbital approach was performed in all 14 cases. In 12 of 14 patients a catheter assisted successful embolization of the fistula was performed using platinum coils with no relevant residual fistula flow. In two cases, a spontaneous thrombosis of the fistula during the surgical procedure required no further embolization. No postoperative therapy-associated complications were observed. CONCLUSION The described approach is an effective method to embolize dAVFs in selected cases when catheter assisted transvenous and/or transarterial embolization is not successful or not feasible. In this case series we demonstrate an excellent success rate with no therapy-associated major complications.
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Affiliation(s)
- Sophie Trennheuser
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Diagnostic and Interventional Neuroradiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jan Philipp Kühn
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alessandro Bozzato
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Andreas Naumann
- Department of Otorhinolaryngology, plastic surgery and special pain therapy, Bremen Mitte Hospital, Bremen, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Diagnostic and Interventional Neuroradiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
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9
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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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12
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Teoh RJJ, Ain Masnon N, Bahari NA, Ch'ng LS. Acquired proptosis and progressive abducens nerve palsy due to overpacked coiling material: rare sequelae of endovascular treatment for carotid cavernous fistula. BMJ Case Rep 2023; 16:e255406. [PMID: 37816571 PMCID: PMC10565337 DOI: 10.1136/bcr-2023-255406] [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: 10/12/2023] Open
Affiliation(s)
| | - Nurul Ain Masnon
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nor Akmal Bahari
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Li Shyan Ch'ng
- Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Department of Radiology, Faculty of Medicine, UiTM Sungai Buloh, Selangor, Malaysia
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13
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Catapano JS, Srinivasan VM, De La Peña NM, Singh R, Cole TS, Wilkinson DA, Baranoski JF, Rutledge C, Pacult MA, Winkler EA, Jadhav AP, Ducruet AF, Albuquerque FC. Direct puncture of the superior ophthalmic vein for carotid cavernous fistulas: a 21-year experience. J Neurointerv Surg 2023; 15:948-952. [PMID: 36261279 DOI: 10.1136/jnis-2022-019135] [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: 05/10/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Direct puncture of the superior ophthalmic vein (SOV) is an alternative approach to traversing the inferior petrosal sinus for embolization of carotid cavernous fistulas (CCFs). OBJECTIVE To analyze direct SOV puncture for the treatment of CCFs and review the literature. METHODS All patients at a single center, treated for a CCF with direct SOV cannulation between January 1, 2000, and December 31, 2020, were retrospectively analyzed. An additional review of the literature for all case series for direct puncture of the SOV for treatment of CCF was performed. RESULTS During the 21-year study period, direct cannulation of the SOV for treatment of a CCF was attempted for 19 patients, with the procedure aborted for one patient because of an inability to navigate the wire into the distal aspect of the cavernous sinus. In 18 patients with direct SOV CCF treatment, 1 experienced a minor complication with an asymptomatic postoperative hemorrhage. Angiographic cure and improvement of symptoms were achieved in 17 patients with a mean (SD) follow-up of 6 (5.2) months. In the review of the literature, an additional 45 patients were reported to have direct cannulation of the SOV for CCF treatment, with angiographic cure in 43 (96%) and decreased objective visual acuity in 1 (2%). CONCLUSION Direct SOV cannulation to treat CCFs is safe and effective. Although it is typically used after other endovascular approaches have failed, SOV access for CCF treatment may be warranted as a first-line treatment for select patients.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nicole M De La Peña
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Rohin Singh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - D Andrew Wilkinson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark A Pacult
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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14
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Karas PJ, Lee JE, Oliver BT, Allison RZ, Lees KA, Shaltoni H, Kan P. Endoscopic endonasal transsphenoidal Onyx embolization of a paracavernous dural arteriovenous fistula. J Neurointerv Surg 2023; 15:1055. [PMID: 36944494 DOI: 10.1136/jnis-2022-019971] [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: 12/22/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
Paracavernous dural arteriovenous fistulas (pdAVFs) are extremely rare and can mimic carotid cavernous fistulas (CCFs) in both clinical presentation and imaging characteristics. Access to the venous pouch often presents the greatest challenge in the treatment of pdAVFs. Here we present a novel access technique utilizing an endoscopic endonasal transsphenoidal approach, where we directly puncture the venous pouch under both stereotactic guidance and endoscopic visualization, thereby completely embolizing a pdAVF with no alternate access (video 1). neurintsurg;15/10/1055/V1F1V1Video 1Technical video demonstrates the complete embolization of a pdAVF using an endoscopic endonasal transsphenoidal approach.
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Affiliation(s)
- Patrick J Karas
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Jae Eun Lee
- Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Brian T Oliver
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Randall Z Allison
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Katherine A Lees
- Otolaryngology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Hashem Shaltoni
- Neurology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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15
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Young M, Enriquez-Marulanda A, Shutran M, DiNobile D, Taussky P, Ogilvy CS. Delayed Rupture of a Cavernous Carotid Aneurysm After Flow Diversion Resulting in Direct Carotid-Cavernous Fistula Treated With Transvenous Embolization: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e238-e239. [PMID: 37427939 DOI: 10.1227/ons.0000000000000817] [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: 02/23/2023] [Accepted: 05/08/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Michael Young
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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16
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Koka K, Alam MS, Halbe S, Jaisankar D, Mukherjee B. Intermittent Manual Carotid Compression as a Treatment Option for Indirect Low Flow Carotid Cavernous Fistula. Orbit 2023; 42:502-509. [PMID: 36285708 DOI: 10.1080/01676830.2022.2136203] [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: 06/06/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To evaluate the efficacy of intermittent manual carotid compression (IMCC) in the management of low-flow carotid cavernous fistulae (CCF). MATERIALS AND METHODS Patients diagnosed with low-flow CCF and treated with IMCC over a period of 13 years were retrospectively analyzed. Data analyzed included demographic details, clinical features, type of CCF, and response to therapy. Outcomes were categorized as complete cure, partial cure, and no cure or worsening. Patients with complete and partial cure were grouped as good outcome whereas those with no cure or worsening as poor outcome. RESULTS A total of 44 patients were advised IMCC for low-flow CCF, of whom five were lost to follow-up. Results of the remaining 39 patients were analyzed, of whom 21 (53.8%) were males. The mean age at presentation was 54.38 ± 14.54 years. The median duration between the onset of symptoms and presentation was 5.0 ± 4.10 months. The common presenting features were episcleral congestion and proptosis (89.7%), extraocular motility restriction (66.7%), and diplopia (48.7%). Most common CCF type was type D (34, 87.2%). All patients were advised to undergo IMCC. Good outcome was seen in 35 patients (89.7%, 95% CI: 80.2% to 99.2%), whereas poor outcome was seen in four (10.3%) patients. The mean duration of follow-up was 15.91 ± 21.87 months. CONCLUSION The present study found a good outcome with IMCC in 89.7% cases of indirect low-flow CCF with no major complications. It should be considered the management of choice in patients who are systemically unfit or cannot afford endovascular embolization.
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Affiliation(s)
- Kirthi Koka
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla, Sankara Nethralaya (A Unit of Medical Research Foundation, Chennai), Kolkata, India
| | - Swatee Halbe
- Department of Interventional Radiology, Apollo Speciality Hospitals, Chennai, India
| | - Durgasri Jaisankar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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17
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Temkar S, Jayaseelan J, Deb AK, Kaliaperumal S. Neovascular glaucoma with combined retinal vascular occlusion in carotid cavernous fistula. BMJ Case Rep 2023; 16:e253197. [PMID: 37076195 PMCID: PMC10124193 DOI: 10.1136/bcr-2022-253197] [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] [Indexed: 04/21/2023] Open
Abstract
Carotid cavernous fistulas (CCFs) can present with varied ophthalmic manifestations. The most important vision-threatening complications of CCF include glaucoma and retinal vascular occlusions. We report a case of a man in his early 30s who developed a post-traumatic direct CCF. The patient denied undergoing embolisation therapy. This resulted in aggravation of his condition with onset of combined retinal venous and artery occlusion leading to neovascular glaucoma and severe vision loss. He was treated with medical management followed by diode laser photocoagulation to control intraocular pressure. Diagnostic cerebral angiography done 3 months later showed complete closure of the fistula; hence, no further intervention was advocated. Combined vascular occlusion is a rare vision-threatening occurrence in cases of CCF. Timely intervention with closure of the fistula can prevent the development of vision-threatening complications.
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Affiliation(s)
- Shreyas Temkar
- Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Jagadeeshwari Jayaseelan
- Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Amit Kumar Deb
- Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Subashini Kaliaperumal
- Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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18
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Sarkis Y, Worden A, Schreiber T, Lapitz A. High index of suspicion: diagnosing a carotid-cavernous fistula. BMJ Case Rep 2023; 16:e253473. [PMID: 36863755 PMCID: PMC9990649 DOI: 10.1136/bcr-2022-253473] [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] [Indexed: 03/04/2023] Open
Abstract
A woman in her 70s presented with acute bilateral retro-orbital headache, diplopia, chemosis and eye swelling. Ophthalmology and neurology were consulted after detailed physical examination and diagnostic workup including laboratory analysis, imaging and lumbar puncture. The patient was diagnosed with non-specific orbital inflammation and was started on methylprednisolone and dorzolamide-timolol for intraocular hypertension. The patient's condition improved slightly, but a week later, she developed subconjunctival haemorrhage in the right eye, which prompted investigation for a low-flow carotid-cavernous fistula. Digital subtraction angiography showed bilateral indirect carotid-cavernous fistula (Barrow type D). The patient underwent bilateral carotid-cavernous fistula embolisation. Her swelling improved considerably on day 1 after the procedure and her diplopia improved over the following weeks.
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Affiliation(s)
- Yara Sarkis
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Astin Worden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Torsten Schreiber
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alvaro Lapitz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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19
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Deepalam SR, Reddy Kankara S, Menezes CR, Goddu Govindappa SK. Transfacial venous embolisation of a spontaneous indirect paediatric caroticocavernous fistula. BMJ Case Rep 2023; 16:e252149. [PMID: 36609418 PMCID: PMC9827181 DOI: 10.1136/bcr-2022-252149] [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] [Indexed: 01/09/2023] Open
Abstract
We present a rare case of a spontaneous indirect caroticocavernous fistula (CCF) in an early adolescent, who exhibited a 1-month history of redness, decrease in vision and proptosis of the right eye without a history of trauma or connective tissue disorder. An MRI of the brain and orbit and a digital subtraction angiography confirmed the diagnosis of Barrow type D CCF. The same was then treated with coiling and a liquid embolising agent using the transfacial venous route, resulting in complete obliteration. Reduction in conjunctival congestion with mild improvement in visual acuity was noted postprocedure. Complete recovery was noted at the 6-month follow-up visit. CCF, though rare in the paediatric population, should be highly considered in the differential diagnosis when the above-mentioned complaints are present. Early diagnosis and intervention have favourable outcomes.
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Affiliation(s)
| | - Shreyas Reddy Kankara
- Radiodiagnosis, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Clyde Richard Menezes
- Radiodiagnosis, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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20
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Chan Chung C, Wen DW, Chew TLT, See SJ. Incomplete Third Nerve Palsy Due to a Carotid-Cavernous Fistula. Neurologist 2023; 28:49-53. [PMID: 35442935 DOI: 10.1097/nrl.0000000000000437] [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: 01/10/2023]
Abstract
INTRODUCTION The approach to oculomotor nerve palsies involves the exclusion of compressive, infective, inflammatory, or ischemic lesions. Dural arteriovenous fistulae, including carotid-cavernous fistulae (CCF), are known causes of third nerve palsy. However, diagnosis can sometimes be delayed or missed due to the various clinical presentations. CCF remains a rare but treatable cause of third nerve palsy. CASE REPORT A 63-year-old Chinese female presented to our unit with gradual onset horizontal diplopia. Clinical examination revealed a partial left oculomotor nerve palsy without congestive eye symptoms. A cerebral angiogram revealed a left indirect CCF supplied by the inferolateral trunk of the left internal carotid artery. She underwent successful transvenous embolization. She improved postprocedure and was discharged well on day 10 of her admission. She was reviewed at 2 months follow-up and had recovered completely. CONCLUSION Our case is a classic description of a CCF with posterior drainage into the inferior petrosal sinus. We hope this case and a review of the literature can serve as a reminder to clinicians of the varied presentations of CCF. We believe this case adds value to the clinicians in contributing to their diagnostic process and to our interventional colleagues in highlighting a case with a successful postembolization outcome.
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Affiliation(s)
- Charles Chan Chung
- Department of Neurology, National Neuroscience Institute, Duke-NUS Medical School
| | - David Wei Wen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Tricia Li Ting Chew
- Department of Neurology, National Neuroscience Institute, Duke-NUS Medical School
| | - Siew Ju See
- Department of Neurology, National Neuroscience Institute, Duke-NUS Medical School
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21
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Min XF, Yuan G, Si GY, Xu YN. Direct puncture the superior ophthalmic vein guiding by Dyna-CT to obliterating a traumatic carotid-cavernous sinus fistula: A case report and literature review. Medicine (Baltimore) 2022; 101:e31560. [PMID: 36316851 PMCID: PMC9622646 DOI: 10.1097/md.0000000000031560] [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: 11/23/2022] Open
Abstract
RATIONALE Traumatic carotid-cavernous sinus fistula (TCCF) is a pathological shunt between the carotid arteries and cavernous sinus due to trauma. Imaging-guided (e.g., ultrasonic image and fluoroscopic roadmap image) direct puncture of the superior ophthalmic vein (SOV) for embolization of TCCF has been previously described in other studies. PATIENT CONCERNS AND DIAGNOSIS We report a case of TCCF in a 58-years-old male patient who was admitted to our hospital with a sustained head injury after falling from a high platform, resulting in rapidly progressive swelling, pain, diminishing vision for more than 6 months, and blindness in his left eye for 1 month. INTERVENTIONS AND OUTCOMES The patient underwent digital subtraction angiography and endovascular embolization. After the failure of super-selection of the left cavernous sinus, an alternative approach to obliterating the TCCF by puncturing the SOV is directly guided by Dyna-CT. After embolization, the patient's clinical symptoms gradually disappeared and discharged from the hospital 5 days later. No recurrence or complications occurred during follow-up for 1 year. CONCLUSION This case illustrates that direct puncture of the SOV guided by Dyna-CT as an alternative approach to embolization of TCCF is safe, effective, and feasible.
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Affiliation(s)
- Xue-Feng Min
- Department of Neurosurgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Gang Yuan
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Guang-Yan Si
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yan-Neng Xu
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- * Correspondence: Yan-Neng Xu, Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China (e-mail: )
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22
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Arat YO, İnam O, Yavas GF, Arat A. The role of choroidal optical coherence tomography for follow-up of carotid cavernous fistula with anterior drainage. Eye (Lond) 2022; 36:2020-2027. [PMID: 34408315 PMCID: PMC9500102 DOI: 10.1038/s41433-021-01744-2] [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: 01/10/2021] [Revised: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To evaluate the role of the choroidal vascularity index (CVI) and the tortuosity index (TI), along with choroidal thickness measurements, in follow-up for anteriorly draining carotid cavernous fistulas (CCF) that would otherwise necessitate an invasive carotid angiogram. METHODS In this longitudinal observational study, analysis of enhanced depth imaging spectral domain optical coherence tomography (SD-EDI-OCT) images of 22 patients with angiographically proven unilateral CCF with anterior drainage was performed for subfoveal choroidal thickness (SFCT), central foveal thickness (CFT), CVI and TI. Baseline measurements were compared with those taken at the last visit after occlusion of the fistula. RESULTS Both in the clinically affected and unaffected eyes, there was a significant decrease in CFT (p = 0.015 and p = 0.005, respectively), SFCT (p = 0.000 for both eyes), CVI (p = 0.002 and 0.001, respectively) and all three TI parameters, including inferior (p < 0.001 and p = 0.01, respectively) and superior temporal vein tortuosity index (p = 0.005 and p = 0.02, respectively) as well as total venular tortuosity index (p < 0.001 and p = 0.002, respectively) after successful closure of the fistula compared to first presentation. Changes in all parameters were similar between the D-CCF and I-CCF groups except for CVI. CONCLUSIONS In this first study concerning follow-up of anteriorly draining unilateral CCFs by SD-EDI-OCT, we not only demonstrated involvement of the clinically unaffected eye but also showed that, this modality, utilizing CVI and TI together with choroidal thickness measurements, can be used as a readily available, noninvasive first-line followup method for evaluating occlusion of fistulas by endovascular treatment or spontaneous resolution.
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Affiliation(s)
- Yonca Ozkan Arat
- Department of Ophthalmology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Onur İnam
- Department of Biophysics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Guliz Fatma Yavas
- Department of Ophthalmology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Anil Arat
- Department of Radiology, Division of Interventional Neuroradiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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23
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Agrawal M, Kumari L, Vichare N, Shyamsundar K, Avasthi A, Gupta S. Carotid-cavernous fistula masquerading as thyroid associated orbitopathy: a diagnostic challenge. Rom J Ophthalmol 2022; 66:168-172. [PMID: 35935074 PMCID: PMC9289768 DOI: 10.22336/rjo.2022.33] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mohini Agrawal
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Lalitha Kumari
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Nitin Vichare
- Department of Ophthalmology, Command Hospital, Pune, India
| | | | | | - Simple Gupta
- Department of Ophthalmology, Command Hospital, Pune, India
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24
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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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25
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Abstract
A male in his early teens presented with redness of the right eye following a fall. This redness was progressive and increased suddenly over the week prior to presentation. Fundus evaluation revealed an exudative retinal detachment, and a bruit was audible over the right eye. A digital subtraction angiogram revealed the cause to be a ruptured persistent trigeminal artery aneurysm causing a carotid-cavernous fistula like haemodynamic situation with a massively dilated superior ophthalmic vein. Curative embolisation was done using both vertebrobasilar and carotid approach, and the aneurysm as well as the fistula was occluded using detachable coils and n-butyl cyanoacrylate glue. Patient made a complete recovery in his proptosis and chemosis over 8 weeks, with significant improvement of his visual acuity. The key to successful outcome in this case was a complete occlusion with thrombosis of the fistula bed that can only be achieved using a combination of coils and liquid embolic agents.
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Affiliation(s)
- Arpan Dutta
- Department of Neurology, Bangur Institute of Neurology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Subhadeep Gupta
- Department of Neurology, Bangur Institute of Neurology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Deep Das
- Department of Neurology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
- Department of Neurology, Calcutta Medical Research Institute, Kolkata, West Bengal, India
| | - Rahul Kumar
- Department of Neurology, G S Neuroscience Clinic and Research Center, Patna, Bihar, India
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26
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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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27
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Wang A, Halbach VV, Dowd CF, Alexander MD, Hallam DK, Ghodke B, Moazami G, Mandigo GK, Lavine SD, Meyers PM. Delayed-Onset Cranial Nerve Palsy After Transvenous Embolization of Indirect Carotid Cavernous Fistulas. J Neuroophthalmol 2021; 41:e639-e643. [PMID: 32868558 DOI: 10.1097/wno.0000000000001067] [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: 10/23/2022]
Abstract
BACKGROUND Carotid cavernous fistulas (CCF) often present with diplopia secondary to cranial nerve palsy (CNP). Immediate development of postoperative CNP has been described in the literature. This study described delayed-onset of CNP after complete and reconfirmed obliteration of the CCF and resolution of initial CNP. METHODS A retrospective analysis was performed on patients with indirect CCF between 1987 and 2006 at 4 academic endovascular centers. Details of the endovascular procedures, embolic agents used, and complications were studied. Partial or complete obliteration was determined. Immediate and delayed cranial nerve palsies were independently assessed. RESULTS A total of 267 patients with symptomatic indirect CCF underwent transvenous endovascular treatment. Four patients (1.5%) developed delayed abducens nerve (VI) palsy after complete resolution of presenting symptoms after embolization. Delayed presentation ranged between 3 and 13 months after complete resolution of initial double vision and cranial nerve palsies. Transvenous coil embolization through the inferior petrosal sinus was performed in all 4 affected patients. All had follow-up angiography confirming durable closure of their CCF. MRI did not show new mass lesions or abnormal soft tissue enhancement. In all 4 patients, their abducens nerve (VI) palsy remained. CONCLUSIONS Delayed CNP can develop despite complete endovascular obliteration of the CCF. The cause of delayed CNP is not yet determined, but may represent fibrosis and ischemia. Long-term follow-up is needed even after complete neurological and radiological recovery is attained in the immediate perioperative period.
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Affiliation(s)
- Arthur Wang
- Neurosurgery and Radiology (AW, GKM, SDL, PMM), Columbia University Medical Center, New York, New York; Radiology and Biomedical Imaging (VVH, CFD), UCSF, San Francisco, California; Radiology and Imaging Sciences (MDA), University of Utah, Salt Lake City, Utah; Radiology (DKH, BG), University of Washington, Seattle, Washington; and Department of Ophthalmology (GM), Columbia University Medical Center, New York, New York
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28
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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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29
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Jareczek FJ, Padmanaban V, Church EW, Simon SD, Cockroft KM, Wilkinson DA. Balloon-Assisted Roadmap Technique to Enable Flow Diversion of a High-Flow Direct Carotid-Cavernous Fistula. J Stroke Cerebrovasc Dis 2021; 31:106180. [PMID: 34823090 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106180] [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: 06/28/2021] [Revised: 10/06/2021] [Accepted: 10/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of flow diverters as a first-line treatment for direct carotid cavernous fistula (CCF) is a relatively new approach in the neurointerventional field which allows obliteration of the fistula with less mass effect from coils in the cavernous sinus. Safe and successful deployment of a flow diverter requires adequate imaging of the parent vessel, which may be challenging in the setting of high-flow CCF without antegrade flow. OBJECTIVE To facilitate adequate parent vessel imaging in the setting of high-flow CCF to enable the safe development of a flow diverter device. METHODS Here we present the case of a patient with delayed presentation of post-traumatic direct CCF after a motor vehicle accident, with no antegrade flow past the fistulous connection. We used temporary balloon occlusion of the fistulous connection to enable road-map imaging of the parent vessel and flow-diverter placement. "Drag and drop" device opening in the middle cerebral artery facilitated better deployment of the flow-diverter against retrograde cavernous flow through the fistula. RESULTS Temporary balloon occlusion of the fistulous connection was used to acquire a roadmap to facilitate safe deployment of a flow diverter and subsequent treatment of the CCF with transvenous coil embolization, with complete resolution of symptoms. CONCLUSION Balloon-assisted roadmap use is a novel means of visualizing the parent vessel in direct CCF to facilitate safe flow diverter deployment.
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Affiliation(s)
- Francis J Jareczek
- Penn State Health Milton S. Hershey Medical Center, Department of Neurosurgery, 500 University Dr. Hershey, PA, 17033, USA
| | - Varun Padmanaban
- Penn State Health Milton S. Hershey Medical Center, Department of Neurosurgery, 500 University Dr. Hershey, PA, 17033, USA
| | - Ephraim W Church
- Penn State Health Milton S. Hershey Medical Center, Department of Neurosurgery, 500 University Dr. Hershey, PA, 17033, USA
| | - Scott D Simon
- Penn State Health Milton S. Hershey Medical Center, Department of Neurosurgery, 500 University Dr. Hershey, PA, 17033, USA
| | - Kevin M Cockroft
- Penn State Health Milton S. Hershey Medical Center, Department of Neurosurgery, 500 University Dr. Hershey, PA, 17033, USA
| | - D Andrew Wilkinson
- Penn State Health Milton S. Hershey Medical Center, Department of Neurosurgery, 500 University Dr. Hershey, PA, 17033, USA.
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30
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Robbins JO, Chhaya N, Schaefer JL. Complete Resolution of Traumatic Indirect Carotid-Cavernous Fistula Two Years After Inciting Event. R I Med J (2013) 2021; 104:70-72. [PMID: 34705914] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Indirect carotid cavernous fistulas (CCFs) are most often spontaneous, but can rarely be caused by trauma. With traumatic etiology, the timeline for the development of symptoms varies significantly and can be difficult to predict. In this report, we discuss the case of a patient found to have an indirect CCF who presented for acutely worsening ocular symptoms and a history of pulsatile tinnitus that began two years prior after a suspected inciting head injury. To our knowledge, no cases have described a traumatic indirect CCF with a similarly extensive indolent course who demonstrated full symptomatic recovery following treatment.
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Affiliation(s)
- James O Robbins
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Nisarg Chhaya
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Jamie L Schaefer
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI
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Giragani S, Kasireddy AR, Agrawal V, Muthyala S. Unilateral Basal Ganglia Hyperintensity Secondary to Venous Congestion in a Case of Indirect Carotico-cavernous Fistula. Neurol India 2021; 69:1048-1050. [PMID: 34507443] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Intraparenchymal venous congestive changes secondary to carotico-cavernous fistula are not common. Isolated basal ganglia venous congestive changes in carotico-cavernous fistula have been rarely described. We report MRI findings of the unilateral basal ganglia hyperintensity, angiographic features including cortical venous reflux into a variant basal vein of Rosenthal, in a postpartum woman presenting with the left eye proptosis and the right upper limb weakness. We also describe the reversal of imaging findings and resolution of patients' symptoms after definitive treatment of the carotico-cavernous fistula by endovascular embolization.
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Affiliation(s)
- Suresh Giragani
- Department of Neuroradiology and Interventional Radiology, Yashoda Hospitals, Alexander Road, Secunderabad, Telangana, India
| | - Ashok Reddy Kasireddy
- Department of Neuroradiology and Interventional Radiology, Yashoda Hospitals, Alexander Road, Secunderabad, Telangana, India
| | - Vikas Agrawal
- Department of Neurology, Yashoda Hospitals, Alexander Road, Secunderabad, Telangana, India
| | - Swathi Muthyala
- Department of Neuroradiology and Interventional Radiology, Yashoda Hospitals, Alexander Road, Secunderabad, Telangana, India
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Cho MJ, Yi KS, Choi CH, Yum KS, Cha SH, Kim Y, Lee J. Sphenoid sinus pseudoaneurysm with carotid cavernous fistula presenting with delayed subarachnoid hemorrhage: A case report. Medicine (Baltimore) 2021; 100:e26383. [PMID: 34128900 PMCID: PMC8213310 DOI: 10.1097/md.0000000000026383] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotid artery (ICA) caused by traumatic vessel injury is rare, and rarer is a concomitant carotid-cavernous fistula (CCF). In particular, delayed subarachnoid hemorrhage (SAH) due to pseudoaneurysm rupture has not been reported to-date in literature. Here, we report a case of sphenoid sinus pseudoaneurysm with CCF presenting with delayed SAH. PATIENT CONCERNS A 73-year-old man presented with traumatic brain injury due to motorcycle accident. DIAGNOSES Twenty-four days after admission, the patient's neurological status suddenly deteriorated. Brain computed tomography (CT) showed acute SAH along interhemispheric cisterns and suprasellar intracerebral hematoma. Brain CT angiography and digital subtraction angiography revealed giant sphenoid sinus pseudoaneurysm with CCF and the daughter sac of the pseudoaneurysm extended to the intracranial part via fracture in the superior wall of the sphenoid sinus. INTERVENTIONS As the sphenoid sinus pseudoaneurysm and CCF shared one rupture point, endovascular treatment with intraarterial approach using coil and liquid embolic material by balloon assisted technique was performed simultaneously. OUTCOMES The origin of the pseudoaneurysmal sac and CCF was sufficiently blocked after injection of liquid embolic material and the lesions completely resolved immediately after endovascular treatment. LESSONS Sphenoid sinus pseudoaneurysm and CCF rarely occur following head trauma through a series of processes involving fracture of the lateral wall of the sphenoid sinus and ICA cavernous segment injury. Sphenoid sinus pseudoaneurysm may present as SAH through intracranial rupture with concomitant superior wall fracture of the sphenoid sinus. Therefore, early diagnosis using CT or magnetic resonance angiography and appropriate treatment through understanding the disease mechanism is necessary.
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Affiliation(s)
- Min Jai Cho
- Department of Radiology
- Department of Neurosurgery
| | | | - Chi-Hoon Choi
- Department of Radiology
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Kyu Sun Yum
- Department of Radiology
- Department of Neurology
| | - Sang-Hoon Cha
- Department of Radiology
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | | | - Jisun Lee
- Department of Radiology
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
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Chugh AJS, Duan Y, Hu YC. Treatment of a rare and complex carotid-cavernous fistula. BMJ Case Rep 2021; 14:14/3/e240596. [PMID: 33753387 PMCID: PMC7986872 DOI: 10.1136/bcr-2020-240596] [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] [Indexed: 11/03/2022] Open
Abstract
Carotid-cavernous fistulas (CCFs) are abnormal connections between arteries and the cavernous sinuses. Traditionally, the Barrow Classification system has been used to characterise these fistulas based on their arterial supply from the internal carotid artery (ICA), external carotid artery (ECA) or both. We present a unique case of a patient with a complex CCF with arterial feeders from dural branches of the ECA, ICA and vertebral artery (VA), which, to our knowledge, has not been reported in the literature. Given unique arterial supply pattern involving contribution from the extracranial VA, this CCF falls outside of the traditional Barrow Classification system. The patient ultimately underwent a transfemoral transvenous coil embolisation using multiple dynamic venous routes with obliteration of bilateral CCFs and near complete resolution of her preoperative symptoms.
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Affiliation(s)
- Arunit J S Chugh
- Department of Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
| | - Yifei Duan
- Department of Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
| | - Yin C Hu
- Department of Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
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Fiutko AN, Koes J, Straus HE, Aks S. Man With Double Vision. Ann Emerg Med 2021; 77:179-220. [PMID: 33487314 DOI: 10.1016/j.annemergmed.2020.07.027] [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: 03/07/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Amber N Fiutko
- Department of Emergency Medicine, Cook County Health, Chicago, IL
| | - Joseph Koes
- Department of Emergency Medicine, Cook County Health, Chicago, IL
| | - Helen E Straus
- Department of Emergency Medicine, Cook County Health, Chicago, IL
| | - Steven Aks
- Department of Emergency Medicine, Cook County Health, Chicago, IL
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Ghorbani M, Lafta G, Rahbarian F, Mortazavi A. Treatment of post-traumatic direct carotid-cavernous fistulas using flow diverting stents: Is it alone satisfactory? J Clin Neurosci 2021; 86:230-234. [PMID: 33775333 DOI: 10.1016/j.jocn.2021.01.047] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Direct carotid cavernous fistula (CCF) occurs between the internal carotid artery (ICA) and the cavernous sinus. Carotid cavernous fistulas (CCFs) frequently present with chemosis, pulsatile proptosis, ocular bruit, vision loss, and occasionally intracerebral hemorrhage or seizure. In this article, we share our experience in endovascular treatment of six patients having this pathology with intracranial flow diverting stents with review of literatures. CASE DESCRIPTION All six patients had posttraumatic direct CCF, most of their signs and symptoms were visual disturbance, chemosis, orbital bruit, headache, paralysis of extraocular muscles. They were treated with flow diversion stents with or without coils or liquid embolizing material; transvenous and transarterial routes were used. Most of them underwent multiple sessions, and their conditions were improved dramatically. CONCLUSION The best and most effective method is to start the procedure by coiling to convert the high-flow fistula to an aneurysmal pouch with the smallest possible size in the cavernous sinus, and then close the defect site with one or two flow diversion devices (FDDs).
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ghazwan Lafta
- Department of Surgery, Faculty of Medicine, University of Al-Ameed, Karbala, Iraq
| | - Farhad Rahbarian
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
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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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Ting W, Richard SA, Changwei Z, Chaohua W, Xiaodong X. Concomitant occurrence of clinoid and cavernous segment aneurysms complicated with carotid cavernous fistula: A case report. Medicine (Baltimore) 2019; 98:e18184. [PMID: 31770272 PMCID: PMC6890289 DOI: 10.1097/md.0000000000018184] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/10/2019] [Accepted: 10/30/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Dual aneurysms arising from the internal cerotic artery (ICA) is a very rare occurrence. Clinoid segment aneurysms (CSAs) are often seen at the carotid dural rings while cavernous carotid aneurysms (CCAs) are often a direct communication between the ICA and the cavernous sinus (CS). We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) PATIENT CONCERNS:: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Neurological examinations were unremarkable. DIAGNOSIS Magnetic resonance imaging (MRI) and computer tomography (CT)-scan revealed dual aneurysms on the ICA. Digital subtracting angiogram (DSA) confirmed a small CSA and a large CCA on the right ICA. INTERVENTIONS We treated both aneurysms with PLED and subsequently observed DAR of CCA as a complication. OUTCOMES We successfully occluded the fistula with ONYX (ev3, Irvine, CA) via the trans-venous approach. LESIONS PLED was the best endovascular treatment option though DAR was inevitable. Although the trans-arterial approach may be the gold standard for the managing of CCF, the complex nature of our case made us opt for trans-venous approach. The trans-venous route is very appropriate for fistulas with complex parent arteries.
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Affiliation(s)
- Wang Ting
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
- Department of Medicine, Princefield University, Ho-Volta Region, Ghana
| | - Zhang Changwei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wang Chaohua
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xie Xiaodong
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
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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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Abstract
A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Subsequent imaging revealed an indirect (type D) carotid-cavernous fistula (CCF) with venous drainage into both SOVs and cavernous sinuses. Successful treatment of the CCF with coil embolisation required interdisciplinary teamwork between ophthalmologists and interventional neuroradiologists. The patient made a substantial visual recovery following treatment.
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Affiliation(s)
- Geoffrey Law
- Ophthalmology and Visual Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gavin Docherty
- Ophthalmology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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42
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de Almeida Silva JM, de Aguiar GB, Veiga JCE, Jory M, Conti MLM. [Carotid cavernous fistula with bilateral eye disorders]. Medicina (B Aires) 2019; 79:74. [PMID: 30694194] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- João M de Almeida Silva
- Departamento de Cirugía, Servicio de Neurocirugía, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Guilherme B de Aguiar
- Departamento de Cirugía, Servicio de Neurocirugía, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP, Brasil. E-mail:
| | - José C E Veiga
- Departamento de Cirugía, Servicio de Neurocirugía, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Maurício Jory
- Departamento de Cirugía, Servicio de Neurocirugía, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Mario L M Conti
- Departamento de Cirugía, Servicio de Neurocirugía, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
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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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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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Hsieh YH, Weng TH, Tai MC, Chien KH. Amelioration of acute orbital compartment syndrome following transvenous embolization for an indirect carotid-cavernous fistula: A case report. Medicine (Baltimore) 2017; 96:e9096. [PMID: 29245336 PMCID: PMC5728951 DOI: 10.1097/md.0000000000009096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Orbital compartment syndrome (OCS) is a rare occurrence after transvenous embolization of indirect carotid-cavernous fistula (CCF). A lateral canthotomy and cantholysis are the most commonly performed surgical interventions. In our case, as the acute OCS occurred immediately after an uneventful transvenous embolization, an orbital floor orbitectomy was performed. PATIENT CONCERNS Here, we present a rare case of a 59-year-old patient who required a transvenous embolization of an indirect CCF and subsequently immediately developed an acute OCS. DIAGNOSES An indirect CCF was revealed using brain magnetic resonance angiography and a transvenous embolization of the fistula was performed using coils. Post-embolization angiograms revealed an occlusion of the CCF. INTERVENTIONS After the development of a relative afferent pupillary defect and acute OCS, we performed a lateral canthotomy, superior and inferior cantholysis, and an orbital floor orbitectomy. Subsequently, visual acuity and intraocular pressure improved. LESSONS Our case is the first report of acute OCS occurring after transvenous embolization of a CCF that required further orbital floor decompression to prevent permanent visual loss. Moreover, our case demonstrates that acute OCS may rapidly develop after transvenous embolization due to superior ophthalmic venous (SOV) thrombosis and that an early intervention may reduce the risk of visual impairment.
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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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Liu P, Lv X, Li Y, Lv M. Spontaneous carotid-trigeminal cavernous fistula obliterated using a combination of coils and onyx. Neurol India 2016; 64 Suppl:S115-6. [PMID: 26954953 DOI: 10.4103/0028-3886.178052] [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: 02/07/2023]
Affiliation(s)
| | | | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
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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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Joshi KC, Singh D, Tandon MS. Intrafistula pressure measurement in traumatic carotid cavernous fistulas--key to increasing safety and effectiveness of endovascular coiling. Acta Neurochir (Wien) 2014; 156:1695-700. [PMID: 25030268 DOI: 10.1007/s00701-014-2176-8] [Citation(s) in RCA: 6] [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: 04/27/2014] [Accepted: 07/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Very few diseases demostrate the tremendous variation and capricious results common with the clinical ensemble of carotid cavernous fistulas (CCFs). The treatment modality for CCFs has changed from surgical to endovascular therapy. Many options exist in endovascular therapy ranging from balloons to coils and liquid embolization agents like Onyx. This study was undertaken to assess the role of recording intra-fistula pressure (IFP) during endovascular coiling of CCFs in order to help us better understand the angiodynamics of the fistula and to make coiling safer and effective. METHODS IFP measurement was done in 15 cases of traumatic CCF undergoing endovascular coiling. Patients were prospectively analyzed by pre- and post- procedural clinical profile, degree of recovery and time until fistula occlusion. Univariate analysis was used to find the correlation between the reduction in IFP, the degree of fistula obliteration and time until occlusion. RESULTS Of the 15 patients who underwent endovascular coiling 13 had total occlusion of the fistula, 1 patient had subtotal occlusion and 1 patient had no occlusion of the fistula. There was 100 % internal carotid artery (ICA) patency. Univariate analysis showed a strong correlation between the degree of reduction in IFP and time required for fistula occlusion (p < 0.001). Patients with a significant drop in IFP were also preceived as having a higher chance of fistula occlusion after waiting 30 min. CONCLUSION To our knowledge this is the largest series in published literature focused on using only detachable coils as the first line embolizing agent in treatment of traumatic CCFs. We conclude that IFP monitoring will play an important role in making treatment of CCFs safer and more effective. The aim of coiling the fistula is not to tightly pack the fistula as during treatment of aneurysms; rather it is to reduce flow across the fistula leading to thrombosis thus reducing the requirement of coils.
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Affiliation(s)
- Krishna Chaitanya Joshi
- M S Ramaiah medical college, Institute of Neurosciences, MSR Nagar, MSRIT post, Bangalore, Karnataka, India, 583101,
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