Post-traumatic carotid cavernous fistula: A case report

Trauma ◽  
2021 ◽  
pp. 146040862110317
Author(s):  
Haritha Indulekha ◽  
Sonu Sama ◽  
Saurabh Chandrakar ◽  
Sagarika Panda ◽  
Mohmmad Hashim ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cavernous Sinus ◽  
Road Traffic ◽  
Bone Fractures ◽  
Flail Chest ◽  
Critically Ill Patient ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
History Of

A carotid cavernous fistula is an abnormal connection between the carotid artery and cavernous sinus which is a rare and sight threatening complication of craniofacial trauma. We report a case of a 36-year-old man with history of road traffic accident, flail chest, on mechanical ventilation who developed redness and progressive swelling of right eye. On evaluation, he was found to have right-sided conjunctival chemosis, pulsatile proptosis, and loud bruit on auscultation over right eyeball. Non-contrast computed tomography revealed multiple skull bone fractures with prominence of right-sided cavernous sinus and superior ophthalmic vein. Contrast enhanced magnetic resonance imaging with angiography revealed bulky cavernous sinus with tortuous right superior ophthalmic vein suggestive of right carotid cavernous fistula. Carotid cavernous fistula should be considered as a differential diagnosis for a critically ill patient with history of trauma developing swollen red eyes as the typical signs and symptoms cannot be assessed in patients on mechanical ventilation. The timely diagnosis and prompt treatment can save vision and can improve the outcome.

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.

Percutaneous transfemoral embolization of an indirect carotid—cavernous fistula with cortical venous access to the cavernous sinus

1999 ◽  
Vol 90 (5) ◽  
pp. 959-963 ◽  
Author(s):  
Richard J. Bellon ◽  
Amon Y. Liu ◽  
John R. Adler ◽  
Alexander M. Norbash
Keyword(s):  
Cavernous Sinus ◽  
English Literature ◽  
Venous Access ◽  
Retrograde Approach ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Cortical Vein ◽  
Transvenous Approach

✓ The authors present the case of a 61-year-old man with an indirect carotid—cavernous fistula (CCF). Many now advocate a primary transvenous approach to deal with such lesions, with packing and thrombosis of the cavernous sinus leading to fistula obliteration. Transvenous access to the cavernous sinus via the inferior petrosal sinus is the usual route of access; both surgical and transfemoral superior ophthalmic vein approaches are also well described. In the case presented, the anatomy of the CCF was unfavorable for these approaches and its dominant venous egress was via a single enlarged arterialized cortical vein. The cavernous sinus was accessed with a transfemoral retrograde approach to the cortical draining vein. Successful CCF embolization was documented radiographically and clinically. To the authors' knowledge, this procedure has not been previously described in the English literature.

scholarly journals Posttraumatic Carotid Cavernous Fistula–A Rare Case

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.

scholarly journals Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

Folia Medica ◽  
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.

scholarly journals Long Term Post Traumatic High Flow Carotid Cavernous Fistula with Patent Collateral Vessel : A Case Report

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Luthfy Farhan ◽  
Ridha Dharmajaya
Keyword(s):  
Case Report ◽  
Left Hemisphere ◽  
Cavernous Sinus ◽  
Craniocerebral Trauma ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Left Brain ◽  
History Of ◽  
Carotid Cavernous Sinus Fistula ◽  
The Right

Introduction : A carotid-cavernous sinus fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus. Carotid cavernous fistula (CCF) is a very rare case it's difficult to diagnose. because most CCF patients rarely come for treatment. Case Report : A 33-year-old male presented with history of protrusion of Left eye ball, and double vision for the last 2 years. visual disturbances were found in the right eye for 2 years, blurry vision is increasingly. Bruit was audible in orbital region on the left side. DSA showed that there was a fistula in the left sinus cavernous region, the arteries in the left area showed inadequate to direct the left hemisphere, but in the right arety showed that the right artery was adversely affected right and left brain. Discussion : Traumatic CCFs are the most common type, accounting for up to 75% of all CCFs.87 They have been reported to occur in 0.2% of patients with craniocerebral trauma and in up to 4% of patients who sustain a basilar skull fractur.2 The symptoms and signs of CCF always include eyelid swelling, proptosis, chemosis, and hyperaemia, dilated of vessel and the condition is commonly misdiagnosed as Graves’ophthal-mopathy or inflammatory conjunctivitis.3Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of endovascular intervention in CCFs. Angiographic results in this patient showed a fistula in the left cavernous sinus and inadequate supply of the left artery to the left hemisphere. Conclusion : This case is very unique because the left brain gets blood supply from the right carotid system, with the left carotid artery system inadequate to direct the left hemisphere because of the carotid cavernous fistula on the left side

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.

scholarly journals Transvenous embolization of dural carotid cavernous fistula through the facial and ophthalmic vein

2011 ◽  
Vol 68 (12) ◽  
pp. 1079-1083 ◽  
Author(s):  
Branko Prstojevic ◽  
Mirko Micovic ◽  
Ivan Vukasinovic ◽  
Mirjana Nagulic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
The Right ◽  
Transvenous Approach

Introduction. Dural carotid cavernous fistula is acquired, relatively rare, condition comprising of numerous smallcaliber meningeal arterial branches, draining directly into cavernous sinus. Endovascular therapy is the treatment of choice, preferably by a transvenous approach. In the case of inaccessible inferior petrosal sinus, other alternative routes are considered. We presented a case of dural carotid cavernous fistula completely occluded with Guglielmi detachable coils, using a transvenous approach through facial and superior ophthalmic vein. Case report. A 62-year-old man was referred with a gradual worsening proptosis, red eye, and decreased visual acuity, on the right side. Digital subtraction angiography revealed the presence of a right dural carotid cavernous fistula, predominantly supplied from dural branches of the right internal carotid artery siphon, with minimal contribution from the right middle meningeal artery and contralateral dural branches of the left internal carotid artery siphon. The fistula was drainaged through the dilated superior ophthalmic vein, and via the facial to the internal jugular vein. There was neither pacification of pterygoid and petrous sinuses, nor cortical venous reflux. Endovascular treatment was performed by a transvenous approach. A guiding catheter was placed in the right facial vein. A microcatheter was advanced through the dilated angular and superior ophthalmic vein, and its tip positioned into the right cavernous sinus. Coils were deployed, until a complete angiographic occlusion of the fistula had been achieved. The patient experienced rapid improvement in the symptoms, with complete normalization of his condition one month after the treatment. Conclusion. Coil embolization of dural carotid cavernous fistula by transvenous catheterization, through the facial and superior ophthalmic vein, can be considered as safe and effective treatment option in the presence of marked anterior drainage.

scholarly journals Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Fadzillah Mohd-Tahir ◽  
Ishak Siti-Raihan ◽  
W. H. Wan Hazabbah
Keyword(s):  
Arteriovenous Malformation ◽  
Temporal Lobe ◽  
Cavernous Sinus ◽  
Signs And Symptoms ◽  
Carotid Cavernous Fistula ◽  
Intracranial Arteriovenous Malformation ◽  
Cavernous Fistula ◽  
Ocular Symptoms ◽  
History Of ◽  
One Year

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula.Method. Interventional case report.Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year.Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

scholarly journals A brief history of carotid-cavernous fistula

2016 ◽  
Vol 126 (6) ◽  
pp. 1995-2001 ◽  
Author(s):  
Min Lang ◽  
Ghaith Habboub ◽  
Jeffrey P. Mullin ◽  
Peter A. Rasmussen
Keyword(s):  
Cavernous Sinus ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Arterial System ◽  
Vascular Lesions ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Initial Hypothesis ◽  
History Of ◽  
Carotid Arterial

Carotid-cavernous fistula was one of the first intracranial vascular lesions to be recognized. This paper focuses on the historical progression of our understanding of the condition and its symptomatology—from the initial hypothesis of ophthalmic artery aneurysm as the cause of pulsating exophthalmos to the recognition and acceptance of fistulas between the carotid arterial system and cavernous sinus as the true etiology. The authors also discuss the advancements in treatment from Benjamin Travers' early common carotid ligation and wooden compression methods to today's endovascular approaches.

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