scholarly journals Dural carotid cavernous fistula following hypertensive emergency

2019 ◽  
Vol 12 (9) ◽  
pp. e230823
Author(s):  
Geoffrey Law ◽  
Gavin Docherty
Keyword(s):  
Vision Loss ◽  
Venous Drainage ◽  
Hypertensive Emergency ◽  
Visual Recovery ◽  
Superior Ophthalmic Vein ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Cerebral Angiogram ◽  
Cavernous Fistula ◽  
Type D

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.

Ocular ischaemic syndrome following coil embolisation for direct carotid cavernous fistula

2021 ◽  
Vol 14 (5) ◽  
pp. e242121
Author(s):  
Nithin Teja Gunna ◽  
Anusha Paritala ◽  
Brijesh Takkar ◽  
Jenil Sheth
Keyword(s):  
Visual Function ◽  
Road Traffic ◽  
Road Traffic Injury ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Cerebral Angiogram ◽  
Cavernous Fistula ◽  
Traffic Injury ◽  
Spontaneous Reversal ◽  
Direct Carotid Cavernous Fistula

A 36-year-old man presented with proptosis and external ophthalmoplegia of the left globe following road traffic injury. Cerebral angiogram revealed moderate flow direct carotid cavernous fistula on left side for which coil embolisation was done repeatedly. Subsequently, the patient developed decreased vision in left eye and developed features of left-sided ocular ischaemic syndrome. The patient was treated conservatively with spontaneous reversal of ocular ischaemic syndrome and complete regain of visual function.

Treatment of a carotid cavernous fistula via direct transovale cavernous sinus puncture

2013 ◽  
Vol 119 (1) ◽  
pp. 247-251 ◽  
Author(s):  
Alberto Gil ◽  
Luis López-Ibor ◽  
Gerardo Lopez-Flores ◽  
Hugo Cuellar ◽  
Eduardo Murias ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Foramen Ovale ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Complete Obliteration ◽  
Feasible Alternative ◽  
Carotid Cavernous Fistulas

Endovascular treatment is the treatment of choice for indirect carotid cavernous fistulas (CCFs). Direct surgical obliteration of CCFs is recommended in highly symptomatic patients or in those with an aggressive pattern of venous drainage. However, this is a technically challenging approach associated with significant procedural morbidity. The authors present a case in which they decided to attempt a novel access to the cavernous sinus through the foramen ovale before recommending surgery for an otherwise untreatable dural CCF. This 52-year-old man with an indirect CCF and neurological deficit had undergone several attempts to embolize the shunt by means of the standard approaches. Ultimately direct cavernous sinus access was obtained through the foramen ovale, resulting in complete obliteration of the shunt. The occlusion was radiographically stable at the 6-month follow-up evaluation, and the patient has remained asymptomatic. Percutaneous transovale puncture of a CCF is a feasible alternative to accessing the cavernous sinus when traditional transvenous catheterization or direct superior ophthalmic vein approach is not possible.

Transorbital Endovascular Embolization of Dural Carotid-Cavernous Fistula: Access to Cavernous Sinus through Direct Puncture: Case Examples and Technical Report

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons75-ons83 ◽  
Author(s):  
Shervin R Dashti ◽  
David Fiorella ◽  
Robert F Spetzler ◽  
Felipe C Albuquerque ◽  
Cameron G McDougall
Keyword(s):  
Cavernous Sinus ◽  
Vision Loss ◽  
External Carotid ◽  
Transvenous Embolization ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Direct Puncture ◽  
Cavernous Fistula ◽  
First Case ◽  
History Of

Abstract OBJECTIVE: We present 2 cases of carotid-cavernous fistulas that failed multiple attempts at transarterial and transvenous embolization. Direct transorbital puncture for embolization was successful in curing the fistulas. The relevant anatomy and technique are reviewed. CLINICAL PRESENTATION: The first case is a 39-year-old man who presented with a 2-month history of worsening right-sided chemosis, proptosis, double vision, and progressive right eye vision loss. The second case is a 79-year-old woman with a 5-month history of right-sided chemosis and a 1-month history of complete left ophthalmoplegia. Cerebral angiography revealed an indirect carotid-cavernous fistula (CCF) in both patients, supplied by meningeal branches of the internal and/or external carotid arteries. INTERVENTION: After multiple unsuccessful attempts at transarterial and transvenous embolization, the CCFs were accessed via direct percutaneous transorbital puncture of the inferior and superior ophthalmic veins, respectively. The fistulas were then successfully occluded with a combination of Onyx and detachable coils. CONCLUSION: In rare cases in which more conventional transvenous and transarterial routes to a CCF have been exhausted, direct percutaneous transorbital puncture represents a viable means of achieving catheterization of the fistulous connection. In most cases, where a prominent arterialized superior ophthalmic vein is present, direct puncture represents a reasonable alternative to ophthalmologic cut-down procedures. Transorbital puncture of the inferior ophthalmic vein provides a direct route to the cavernous sinus in cases where the superior ophthalmic vein is atretic and inaccessible by direct surgical cut-down procedures.

scholarly journals Endoscopic endonasal transsphenoidal direct access and Onyx embolization of a dural arteriovenous fistula mimicking a carotid-cavernous fistula: case report

2020 ◽  
pp. 1-5
Author(s):  
Patrick J. Karas ◽  
Robert Y. North ◽  
Visish M. Srinivasan ◽  
Nathan R. Lindquist ◽  
K. Kelly Gallagher ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vision Loss ◽  
Hybrid Approach ◽  
Venous Drainage ◽  
Direct Access ◽  
Carotid Cavernous Fistula ◽  
Endoscopic Endonasal ◽  
Direct Puncture ◽  
Cavernous Fistula

The classic presentation of a carotid-cavernous fistula (CCF) is unilateral painful proptosis, chemosis, and vision loss. Just as the goal of treatment for a dural arteriovenous fistula (dAVF) is obliteration of the entire fistulous connection and the proximal draining vein, the modern treatment of CCF is endovascular occlusion of the cavernous sinus via a transvenous or transarterial route. Here, the authors present the case of a woman with a paracavernous dAVF mimicking the clinical and radiographic presentation of a CCF. Without any endovascular route available to access the fistulous connection and venous drainage, the authors devised a novel direct hybrid approach by performing an endoscopic endonasal transsphenoidal direct puncture and Onyx embolization of the fistula.

Electrothrombosis of carotid-cavernous fistula

1975 ◽  
Vol 42 (1) ◽  
pp. 76-85 ◽  
Author(s):  
Yoshio Hosobuchi
Keyword(s):  
Posterior Segment ◽  
Cerebral Vein ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Arterial Circulation ◽  
Inferior Portion ◽  
Pterygoid Plexus ◽  
Fine Print

✓ The author describes a technique for directly closing a carotid cavernous fistula with electrothrombosis while preserving the intracranial arterial circulation. Copper wires are introduced through the superior ophthalmic vein or a frontotemporal craniotomy, and thus directly into the portion of the sinus into which the fistula drains; if posterior, into the posterior segment of Parkinson's triangle, if inferior, into the pterygoid plexus, and if anterior, through the sphenoparietal sinus and/or middle cerebral vein to the anterior-inferior portion of the sinus. A direct current is applied until a thrombus is confirmed angiographically and the wires are left in place. Four patients treated by this method are presented.

scholarly journals Embolization of dural carotid cavernous fistula via the superior ophthalmic vein approach: a case report

2015 ◽  
Vol 14 (3) ◽  
pp. 118-123
Author(s):  
Nigel CS Lim ◽  
Hazel Anne Lin ◽  
Kok Kee Tang ◽  
Cheng Kang Ong ◽  
Gangadhara Sundar
Keyword(s):  
Case Report ◽  
Operating Theatre ◽  
Viable Alternative ◽  
Type B ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Close Cooperation ◽  
Cosmetic Outcomes

In this case report, we present a patient with Type B dural carotid-cavernous fistula (CCF), who had failed cannulation via the transfemoral route and subsequently underwent CCF occlusion via the anterior orbital approach through the superior ophthalmic vein (SOV). Successful occlusion of CCF was achieved, with excellent visual and cosmetic outcomes postoperatively. When all venous routes have been exhausted, the SOV approach is an excellent and viable alternative in the treatment of dural CCFs. Close cooperation between the orbital and neuro-interventional teams in a hybrid operating theatre setting is essential in ensuring success of the operation.

Burr Hole-Assisted Direct Transsylvian Venous Catheterization for Carotid-Cavernous Fistula Embolization: A Case Report

2020 ◽  
Vol 19 (2) ◽  
pp. E196-E200 ◽  
Author(s):  
Ritam Ghosh ◽  
Fadi Al Saiegh ◽  
Aria Mahtabfar ◽  
Nikolaos Mouchtouris ◽  
Omaditya Khanna ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Vision Loss ◽  
Venous Drainage ◽  
Burr Hole ◽  
Double Vision ◽  
Rapid Improvement ◽  
Type D ◽  
Transsylvian Approach ◽  
Increased Risk ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND AND IMPORTANCE Carotid-cavernous fistulas (CCF) are pathological connections between carotid artery branches and the cavernous sinus. They can lead to a variety of symptoms, such as chemosis and double vision, or more insidious events, such as vision loss and intracranial hemorrhage. Although these patients are often treated by endovascular means, we describe a case in which the patient's CCF was not able to be accessed by usual methods and required an open surgical approach. CLINICAL PRESENTATION The patient had progressive chemosis, double vision, and periorbital pain. Angiogram showed an indirect type D CCF with cortical venous drainage with a large sylvian vein that was directly draining the fistula. The patient did not have a dilated superior ophthalmic vein, and the petrosal sinuses could not be catheterized. Therefore, because of the patient's increased risk for intracranial hemorrhage, she was taken to the operating room for an image guided burr hole for direct catheterization of the sylvian vein. From this point, the fistulous point could be catheterized, and the CCF was embolized using onyx. Follow-up angiogram showed complete occlusion. CONCLUSION This is the first report in literature of an indirect CCF being treated through a transsylvian approach with onyx. This combined open-surgical-and-endovascular approach was necessary to get full resolution of the lesion, and patient had rapid improvement of symptoms.

scholarly journals Post-traumatic carotid-cavernous fistula with bilateral proptosis simulating cavernous sinus thrombosis

2019 ◽  
Vol 12 (3) ◽  
pp. e227757 ◽  
Author(s):  
Nirupama Kasturi ◽  
Pooja Kumari ◽  
Gayatri Nagarajan ◽  
Nagarajan Krishnan
Keyword(s):  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Cavernous Sinus Thrombosis ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Orbital Trauma ◽  
Cavernous Fistula ◽  
Intravenous Antibiotics ◽  
Post Traumatic

A 48-year-old woman presented with bilateral non-pulsatile proptosis and ophthalmoplegia after 3 days following blunt orbital trauma. It was associated with fever, malaise and loss of vision in right eye. She was provisionally diagnosed with cavernous sinus thrombosis and was treated with intravenous antibiotics with no improvement. A subtle bruit was present on examination, and digital subtraction angiography revealed a right direct (type A) carotid-cavernous fistula (CCF). The patient underwent right coil embolisation of direct CCF. On follow-up at 4 months, her proptosis resolved completely and extraocular movements improved.

Traumatic Ophthalmic Fistula Simulating Carotid-Cavernous Fistula

Neurosurgery ◽  
1983 ◽  
Vol 12 (1) ◽  
pp. 102-104 ◽  
Author(s):  
Miguel A. L. Freitas ◽  
Cyro A.B. Filho ◽  
Ranulfo Lima ◽  
Edson Marchiori
Keyword(s):  
Ophthalmic Artery ◽  
Carotid Angiography ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Spontaneous Thrombosis ◽  
Cavernous Fistula ◽  
Repeat Angiography ◽  
The Right

Abstract In a patient with a penetrating lesion of the right orbit with proptosis and a bruit in this region, carotid angiography revealed an ophthalmic fistula between the ophthalmic artery and the superior ophthalmic vein. Three days after admission, the symptoms disappeared, and repeat angiography showed the spontaneous thrombosis of the fistula.

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