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.

scholarly journals A Poorly Treated Carotid-Cavernous Fistula Rescued by Coils through a PComA Approach

2009 ◽  
Vol 15 (2) ◽  
pp. 197-201
Author(s):  
J. Yu ◽  
Z. Shi ◽  
M. Lv ◽  
X. Yang ◽  
Z. Wu
Keyword(s):  
Digital Subtraction Angiography ◽  
Temporal Bone ◽  
Cavernous Sinus ◽  
Ophthalmic Artery ◽  
Parent Artery ◽  
Maxillary Artery ◽  
Digital Subtraction ◽  
Carotid Cavernous Fistula ◽  
Puncture Wound ◽  
Cavernous Fistula

This study describes a case of traumatic carotid-cavernous fistula poorly treated with balloons and rescued by coils through a PComA approach. A six-year-old boy suffered a left temporal bone puncture wound. Digital subtraction angiography disclosed a left carotid cavernous fistula. Five balloons were implanted into the cavernous sinus and the parent artery was sacrificed unwillingly, but the residual fistula retro-engorged by the ophthalmic artery communicated with the maxillary artery and the post circle through the PComA. We finally occluded the residual fistula through the PComA with coils. Once the parent artery was sacrificed and the distal residual fistula still retro-engorged, another patent communicating artery may be a rescue approach.

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 A rare case of bilateral spontaneous indirect caroticocavernous fistula treated previously as a case of conjunctivitis

2018 ◽  
Vol 10 ◽  
pp. 251584141878830
Author(s):  
Shaheryar Khan ◽  
Caspar Gibbon ◽  
Steve Johns
Keyword(s):  
Rare Case ◽  
Arterial System ◽  
Carotid Cavernous Fistula ◽  
Ehlers Danlos Syndrome ◽  
Cavernous Fistula ◽  
Bilateral Carotid ◽  
History Of ◽  
Type C ◽  
Carotid Cavernous Fistulas ◽  
Red Eyes

Carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. We present an interesting, rare case of bilateral spontaneous ‘Barrow type- C’ fistula treated presumptively as conjunctivitis. A 66 year old patient presented in the eye casualty at North Devon District Hospital in January 2016, referred from her General practitioner complaining of bilateral red eyes. She was found to have large, prominently diffused and engorged scleral blood vessels on both sides along with raised intraocular pressures of 26mm of Hg bilaterally. The patient was diagnosed with an indirect carotic cavernous fistulas bilaterally in view of the clinical and radiology findings. Barrow type - C dural fistulas were reported to be seen bilaterally on radiology findings. Patient was referred for interventional treatment to the closest neurosurgical center where she had four failed attempts of coil embolization after which she was referred to a second neurosurgery center at Bristol where she underwent successful coil catheterization as the treatment for her carotid cavernous fistula. Indirect carotid cavernous fistula most commonly occur spontaneously. Bilateral spontaneous indirect carotid cavernous fistula is a very rare diagnosis and and there are very few cases reported in the literature without an underlying etiology or a known cause like Ehlers -Danlos syndrome or diabetes mellitus. Bilateral spontaneous carotid cavernous fistulas are difficult to diagnose due to mild symptoms and no history of trauma. We conclude that carotid cavernous fistulas are a threat to the vision if left untreated due to delayed diagnosis. We recommend considering bilateral carotid cavernous fistula as a differential diagnosis in patients with an ongoing history of red eyes or those unresponsive to conventional topical treatment for conjunctivitis like symptoms.

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.

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

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.

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 Bilateral carotid-cavernous fistula presented with unilateral symptomatology

2018 ◽  
Vol 75 (9) ◽  
pp. 940-943
Author(s):  
Milan Stojcic ◽  
Gordana Djuric ◽  
Lepsa Zoric
Keyword(s):  
Clinical Picture ◽  
Diagnostic Procedures ◽  
Arterial System ◽  
Low Flow ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Non Invasive ◽  
Bilateral Carotid ◽  
Traumatic Origin ◽  
Carotid Arterial

Introduction. Carotid-cavernous fistula presents an abnormal communication between carotid arterial system and the venous cavernous sinus. Due to anatomical characteristics of the sinus, the clinical picture is first manifested as ophthalmic problem. These fistulas are either of spontaneous or traumatic origin with different hemodynamics. They are usually on one side. However, bilateral carotidcavernous fistulas are rare and deserve special interest. Case report. We presented a 76-years-old female patient, who complained on diplopia and right eye protrusion and esotropia. Ophthalmological findings aroused suspicion of a right-side spontaneous carotid-cavernous fistula. Further non-invasive and invasive investigations confirmed our initial diagnosis. Unexpectedly, digital subtraction angiography revealed another fistula, on her left side. Both fistulas were of low flow and did not need therapy. Conclusion. Carotid- cavernous fistula represent certain diagnostic and therapeutic challenge. Although they are not indicated in a clinical picture, sometimes bilateral fistulas can be found during appropriate diagnostic procedures.

scholarly journals Spontaneous direct carotid-cavernous sinus fistula secondary to a persistent primitive trigeminal artery treated by trans-venous coil embolisation

2018 ◽  
Vol 24 (5) ◽  
pp. 567-570 ◽  
Author(s):  
Andrew Imrie ◽  
Kendal Redmond ◽  
David Leggett
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Artery ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Persistent Primitive Trigeminal Artery ◽  
History Of ◽  
Carotid Cavernous Sinus Fistula ◽  
Primitive Trigeminal Artery ◽  
Direct Carotid Cavernous Fistula

A healthy 51-year-old female presented with a spontaneous direct carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. She had no history of connective tissue or cerebrovascular disorders or significant head trauma. This is a rare lesion with only 18 previously reported cases. It had similar clinical presentation and imaging appearance to a high-flow direct carotid-cavernous fistula and was uncovered after successful trans-venous coil embolisation of the fistula. It therefore needs to be considered in cases of direct carotid-cavernous fistula without history of trauma. Knowledge of types of persistent primitive trigeminal artery is also important for their critical treatment implications.

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