Carotid-Cavernous Fistula: An Uncommon and Easily Missed Complication of Head Trauma

A 57-year-old woman attended the emergency department complaining of protrusion of the right eyeball for three days. The history revealed that she had head injury in a road traffic accident about five weeks ago. The accident had caused a fracture of the right angle of the mandible that was fixed internally by the maxillo-facial surgeon. Subsequent angiogram showed a right direct carotid-cavernous fistula. Endovascular therapy was successful in obliterating the fistula. She recovered well. Although carotid-cavernous fistula is an uncommon complication of head injury, emergency physicians should be aware of this condition because of its potential mortality and morbidity.

Download Full-text

Direct Surgery for Posttraumatic Carotid-cavernous Fistula as a Result of an Intradural Pseudoaneurysm: Case Report

Neurosurgery ◽

10.1097/00006123-200210000-00040 ◽

2002 ◽

Vol 51 (4) ◽

pp. 1071-1074 ◽

Cited By ~ 1

Author(s):

Yoshihiko Fu ◽

Kenji Ohata ◽

Naohiro Tsuyuguchi ◽

Mitsuhiro Hara

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Traffic Accident ◽

Internal Carotid ◽

Clinical Presentation ◽

Posterior Communicating Artery ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

The Right ◽

Embolization Procedure

Abstract OBJECTIVE AND IMPORTANCE Traumatic carotid-cavernous fistula (CCF) is currently treated with interventional neuroradiological embolization procedures. A rare case of posttraumatic CCF that resulted from an intradural pseudoaneurysm is presented. The patient was treated by direct surgery because an embolization procedure was not suitable. CLINICAL PRESENTATION A 16-year-old boy developed chemosis in the right eye 17 days after a traffic accident. Angiography revealed a pseudoaneurysm that arose from the site of origin of the posterior communicating artery, drained directly into the cavernous sinus, and formed a high-flow CCF. INTERVENTION Direct surgery was performed to repair the arterial laceration at the junction of the internal carotid artery and the posterior communicating artery. A clip was applied along the internal carotid artery. The posterior stump of the damaged posterior communicating artery was also included in the clip. Postoperatively, the CCF and pseudoaneurysm were completely obliterated, and the symptoms were cured. CONCLUSION Awareness of an unusual intradural origin of a CCF and the possibility of a direct surgical treatment should be kept in mind.

Download Full-text

Posttraumatic Carotid Cavernous Fistula–A Rare Case

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1717218 ◽

2020 ◽

Author(s):

Amit Dahiya ◽

Sumit Dahiya ◽

Suresh Kumar S. ◽

Shrikant V Rege ◽

Gaurav Jatav ◽

...

Keyword(s):

Road Traffic Accident ◽

Traffic Accident ◽

Rare Case ◽

Road Traffic ◽

Young Male ◽

Carotid Cavernous Fistula ◽

Av Fistula ◽

Cavernous Fistula ◽

History Of ◽

Gcs Score

AbstractCarotid cavernous fistula (CCF) is a specific type of dural arteriovenous (AV) fistula characterized by abnormal AV shunting within the cavernous sinus. The authors present a case of a 17-year-old young male who encountered a road traffic accident while driving a car, with a history of flipping of cars multiple times. The patient was unconscious with symmetrical bilateral (B/L) pupils and with Glasgow coma scale (GCS) score of 3. There was no history of seizures or vomiting.

Download Full-text

Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

Folia Medica ◽

10.1515/folmed-2017-0059 ◽

2017 ◽

Vol 59 (4) ◽

pp. 472-476

Author(s):

Stanimir S. Sirakov ◽

Borislav D. Kitov ◽

Kristina S. Sirakova ◽

Ivo I. Kehayov

Keyword(s):

Cavernous Sinus ◽

Embolic Agent ◽

Carotid Cavernous Fistula ◽

Mortality And Morbidity ◽

Cavernous Fistula ◽

History Of ◽

Diagnosis And Classification ◽

Left Eyelid ◽

Direct Carotid Cavernous Fistula

AbstractWe describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. The conventional cerebral panangiography confirmed the diagnosis - a direct carotid-cavernous fistula (CCF), with no evidence of ruptured aneurysm. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the Onyx embolic agent in the fistula. During the first 48 hours after the embolization the local pain, exophthalmos and conjunctival injection of the left eye were significantly ameliorated. The pulsatile tinnitus on the left disappeared and the ptosis of the left eyelid partially recovered. Selective angiography is the best method for the diagnosis and classification of CCF. Currently, treatment is possible with low mortality and morbidity rates. The endovascular intervention is able to completely occlude the fistula and maintain adequate blood fl ow through the carotid artery.

Download Full-text

Ocular ischaemic syndrome following coil embolisation for direct carotid cavernous fistula

BMJ Case Reports ◽

10.1136/bcr-2021-242121 ◽

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.

Download Full-text

CTA-guided outflow-targeted embolization of direct carotid-cavernous fistula

Neurosurgical FOCUS ◽

10.3171/2019.1.focusvid.18447 ◽

2019 ◽

Vol 46 (Suppl_1) ◽

pp. V11 ◽

Cited By ~ 1

Author(s):

Chih-Hsiang Liao ◽

Wen-Hsien Chen ◽

Nien-Chen Liao ◽

Yuang-Seng Tsuei

Keyword(s):

Neurological Deficits ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Complete Obliteration ◽

Outflow Channels ◽

The Right ◽

Visual Blurring ◽

The Brain ◽

Direct Carotid Cavernous Fistula

This video presents a case of new-onset visual blurring, diplopia, and conjunctival injection after head injury. CTA of the brain revealed a direct carotid-cavernous fistula (dCCF) of the right side. Careful evaluation of CTA source images revealed that the fistula point was at the ventromedial aspect of the right cavernous internal carotid artery (ICA), about 3.6 × 3.6 mm2 in size, with 3 main outflow channels (2 intracranial and 1 extracranial) (CTA-guided concept). DSA of the brain also confirmed the diagnosis but was unable to locate the fistula point in a large-sized dCCF. Through a transfemoral artery approach, 3 microcatheters were navigated to each peripheral channel to initiate outflow-targeted embolization. Intracranial refluxes were blocked first to avoid cerebral hemorrhages, followed by the extracranial outflow. During embolization, accidental dislodge of one coil into the sphenoparietal vein occurred, but no attempt of coil retrieval was made. Complete obliteration of the dCCF was achieved, and the patient recovered well without new neurological deficits. 4D MRA at the 3-month follow-up showed no residual dCCF.The video can be found here: https://youtu.be/LH2lNVRZSPk.

Download Full-text

Direct Carotid-Cavernous Fistula with early drainage into inferior petrous sinus

Revista Neurociências ◽

10.34024/rnc.2021.v29.11733 ◽

2021 ◽

Vol 29 ◽

pp. 1-9

Author(s):

Olavo Leite de Macêdo Neto ◽

Amanda Menezes Morgado ◽

Rafael Dos Santos Araujo ◽

José Silva Souza ◽

Ana Carla Da Silva Mendes ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

The Third ◽

The Right ◽

Carotid Cavernous Fistulas ◽

Direct Carotid Cavernous Fistula

Carotid-cavernous fistulas (CCF) are classified in direct (Barrow A) and indirect. The direct comunication between the cavernous segment of the internal carotid artery and the cavernous sinus defines direct CCF. In the present case, is described a 51-year-old female patient, diagnosed with subarachnoid hemorrhage through head tomography. The patient underwent an agiographic study, wen was identified a large dissecant aneurysm in the right internal carotid artery and a direct CCF with early drainage into the ophthalmic vein and inferior petrous sinus, manifesting paralysis of the third cranial nerve.

Download Full-text

Delayed Spontaneous Thrombosis of Neglected Direct Carotid-Cavernous Fistula: A Case Report

Neurointervention ◽

10.5469/neuroint.2020.00094 ◽

2020 ◽

Vol 15 (2) ◽

pp. 96-100

Author(s):

Sarbesh Tiwari ◽

Pawan Kumar Garg ◽

Pushpinder Singh Khera ◽

Santosh Babu K.B ◽

Taruna Yadav ◽

...

Keyword(s):

Internal Carotid ◽

Young Male ◽

Carotid Cavernous Fistula ◽

Parent Vessel ◽

Spontaneous Thrombosis ◽

Vessel Occlusion ◽

Cavernous Fistula ◽

Parent Vessel Occlusion ◽

The Right ◽

Direct Carotid Cavernous Fistula

Direct carotid-cavernous fistula (CCF) refers to direct communication between the cavernous portion of the internal carotid artery (ICA) and the cavernous sinus due to rent in the ICA, most commonly secondary to trauma. These are generally high-flow fistula and rarely resolve spontaneously. We report a case of a young male who developed features of direct CCF after trauma, was denied any treatment for 4 years, and then presented with spontaneous thrombosis of the fistula and a residual large pseudoaneurysm of the cavernous segment of the right ICA, which was subsequently managed with parent vessel occlusion.

Download Full-text

A SURGICAL CASE TO REPOSITION THE RIGHT GLOBE INTO THE ORBIT FOLLOWING A ROAD TRAFFIC ACCIDENT CAUSED BY A SUBARACHNOID HAEMORRHAGE

10.26226/morressier.578e3b4fd462b80292382450 ◽

2016 ◽

Author(s):

Emma Wates

Keyword(s):

Subarachnoid Haemorrhage ◽

Road Traffic Accident ◽

Traffic Accident ◽

Road Traffic ◽

Surgical Case ◽

The Right

Download Full-text

Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1718780 ◽

2021 ◽

Author(s):

Sukriti Das ◽

Bipin Chaurasia ◽

Dipankar Ghosh ◽

Asit Chandra Sarker

Keyword(s):

Head Injury ◽

Road Traffic ◽

Head Injuries ◽

Skull Fracture ◽

Tertiary Care ◽

Acute Subdural Hematoma ◽

Care Hospital ◽

Female Ratio ◽

Mortality And Morbidity ◽

The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

Download Full-text