Orbitofrontal Extradural Hematoma: Unusual Cause of Proptosis

Traumatic orbital subperiosteal hematoma are a distinct entity and should not be confused with orbital extradural hematoma. Most of the orbital subperiosteal hematoma are small in volume and resolve spontaneously. Management should be based on the clinico-radiological condition. A delayed proptosis may be simply due to orbital venous congestion due to a substantial hematoma or due to a carotid-cavernous fistula. Differentiation between the two is paramount to decide management strategy.

Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

Purpose The aim of this study was to determine local diagnostic reference levels (DRLs) during endovascular diagnostics and therapy of carotid-cavernous fistulas (CCF). Methods In a retrospective study design, DRLs, achievable dose (AD) and mean values were assessed for all patients with CCF undergoing diagnostic angiography (I) or embolization (II). All procedures were performed with the flat-panel angiography system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the type of CCF and the type of procedure. Results In total, 86 neurointerventional procedures of 48 patients with CCF were executed between February 2010 and July 2021. The following DRLs, AD and mean values could be determined: (I) DRL 215 Gy ∙ cm2, AD 169 Gy ∙ cm2, mean 165 Gy ∙ cm2; (II) DRL 350 Gy ∙ cm2, AD 226 Gy ∙ cm2, mean 266 Gy ∙ cm2. Dose levels of embolization were significantly higher compared to diagnostic angiography (p < 0.001). No significant dose difference was observed with respect to the type of fistula or the embolization method. Conclusion This article reports on diagnostic and therapeutic DRLs in the management of CCF that could serve as a benchmark for the national radiation protection authorities. Differentiation by fistula type or embolization method does not seem to be useful.

Abstract 1122‐000197: Carotid‐Cavernous Fistula: Does Transcranial Duplex Worth Revisiting?

Introduction : Carotid‐cavernous fistula (CCF) represents a well‐known multifaceted diagnostic challenge starting from clinical presentation till angiography. This case presentation and literature review shed the light on the value of a bedside transcranial duplex (TCD) as a timely and a plausible screening tool. Methods : A case presentation and a brief literature review of CCF diagnosed via transcranial temporal window and made time to angiography shorter than the MRI brain. A review of literature was conducted for the timely diagnostic role of transtemporal TCD compared to transorbital US and an MRI brain. Results : Our case report showed the valuable role of the bedside TCD in diagnosing CCF. There is a limited number of studies which tackled the timely diagnostic role of transtemporal TCD compared to transorbital US and an MRI brain from door to angiography. Conclusions : A large‐sampled randomized controlled trial is needed for evaluating the actual utility of a bed side time and cost‐effective Transtemporal TCD vs other state‐of‐art non‐angiographic diagnostic modalities such as MRI, CT and transorbital US.

Use of coronary stent grafts for the treatment of high-flow carotid cavernous fistula

Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Advancements in the field of endovascular medicine made available other options for the treatment of this condition. Covered stents are widely available and offer preservation of the parent artery while occluding the fistula.