Caroticocavernous fistulas ccf represent abnormal communication between the carotid. Spontaneous arteriovenous communications between the dural branches of the external carotid artery and the cavernous sinus are rare. Carotid cavernous fistulas ccfs are a rare but potentially devastating cause of orbital symptoms, visual loss, and periocular disfigurement. A mass of the eyelid revealing a carotidcavernous fistula. As a result, the blood can drain properly from the eyes. Barrow caroticocavernous fistula classification divides caroticocavernous fistulas into direct type a or indirect types bd. The potentially sightrobbing vascular abnormality known as the carotid cavernous sinus fistula ccf can masquerade as conjunctivitis or other common ocular conditions, which diminishes the chance for a speedy diagnosis. Indirect fistulas types b, c and d are dural arteriovenous fistulas fed by the meningeal arteries of the ica, the external carotid artery eca, or. Carotid cavernous fistulae may form following closed or penetrating head trauma, surgical damage, rupture of an intracavernous aneurysm, or in association with connective tissue disorders, vascular diseases and dural fistulas. What is a carotid cavernous fistula doctor answers. Indirect fistulae are further subdivided according to whether the supply is from the. Based on this classification, our case belongs to type a ii. The patient was treated incrementally and finally cured by a rarely reported bilateral retrograde direct transvenous approach via the superior ophthalmic vein. They are classified into dural cavernous sinus fistulae or direct carotidcavernous fistulae.
Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Efsing a fistula between the internal carotid artery and the cavernous sinus is usually caused by trauma but may result from spontaneous rupture of an aneurysm, as a rule a n. Intracavernous carotid artery aneurysms causing a carotidcavernous fistula ccf are rare. If they do rupture they most often lead to a ccf instead of bleeding into the subarachnoid space. Pathophysiology of carotidcavernous fistulas in vascular. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. As arterial blood under high pressure enters the cavernous sinus, the normal venous return to the cavernous sinus is impeded and this causes engorgement of the draining veins, manifesting most dramatically as a. A carotid cavernous fistula ccf is an abnormal vascular connection between the carotid arterial system and the cavernous sinus. These lesions may be classified based on the following. Combined carotid artery and jugular vein compression resulted in a complete cure in seven of 23 patients 30% and improvement in one additional patient. Presentation and treatment of carotid cavernous aneurysms.
V v halbach, r t higashida, g b hieshima, m reicher, d norman, t h newton. Diagnosis and management of carotid cavernous fistulas. Pdf a 21yearold man presented with severe proptosis, chemosis, diplopia and an orbital bruit three. The traumatic fistulae occur more frequently, 75% of cases, appearing after car accidents or after endovascular therapy. Carotidcavernous fistula an overview sciencedirect topics. Traumatic head injury, particularly basilar skull fractures, can. In most instances, endovascular treatment is preferred. Caroticocavernous fistula radiology reference article. Carotid cavernous sinus fistulas ccfs are abnormal communications between the carotid arterial system and the cavernous sinus. A ccf can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or. Furthermore, we present the images that we used to make the diagnosis.
The fistula was successfully treated angiographically. A 60yearold man with direct carotid cavernous fistula ccf due to a motor vehicle accident underwent internal carotid artery trapping following highflow external carotid to internal carotid artery bypass ecic bypass. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. This separates the blood flow of the carotid arteries from that of the veins. Endovascular treatment strategy for direct carotid cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. Peng and others published carotid cavernous fistula presenting with bilateral abducens palsy find, read and cite all the research you need on researchgate. Direct spontaneous carotid cavernous fistula sccf is reportedly pathognomonic of veds. Apr 15, 2020 carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Carotidcavernous sinus fistula definition of carotid. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Right carotid arterycavernous sinus fistula and left aneurysm.
Carotidcavernous fistulas provide a free communication between the internal carotid artery and the surrounding cavernous sinus, resulting in high blood flow and high mean pressure in the shunt. Selective angiography of the external carotid artery showing an indirect type d right carotid cavernous fistula. A ptient is described with a ruptured intracavernous aneurysm causing a ccf resulting in acute onset of. Carotidcavernous fistula how is carotidcavernous fistula. Vascular ehlersdanlos syndrome veds is a rare condition characterized by connective tissue fragility. Imaging diagnosis of dural and direct cavernous carotid. Endovascular treatment of direct carotid cavernous. Endovascular treatment of these lesions is challenging. Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. Carotid cavernous fistula is an abnormal arteriovenous communication between the carotid artery or its branches and the cavernous sinus. Development of indirect cavernous dural arteriovenous. We also describe the technique, symptomatology and complications associated with the procedure and report on the longterm followup in our treated. Traumatic carotidcavernous sinus fistula sciencedirect.
The diagnostic angiogram was performed to evaluate the supply and drainage of the fistula. Followup angiography revealed ipsilateral complex indirect cavernous arteriovenous fistula. Dural carotid cavernous fistulas are usually treated via a transvenous approach through the inferior petrosal sinus. Symptoms are often abrupt in onset and rapidly progressive, and ccf requires immediate treatment if there is progressive visual impairment. Carotidcavernous fistula definition of carotidcavernous. It is usually associated with a skull base, frontal or midfacial fracture, but it may also be a spontaneous phenomenon of congenital, inefective or degenerative origin. A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. We evaluated drainage patterns of ccfs by digital subtraction angiography dsa and categorized drainage pathways according to their types and etiology. Treatment of carotid cavernous fistulas request pdf. Treatment of carotid cavernous fistulas northwestern. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus.
Pdf carotid cavernous fistula ccf is an abnormal communication between the. The shunting of the blood may produce ocular ischemia 503 and may transmit arterial pulsations. Ruptured cavernous sinus aneurysms causing carotid. Such malformations may be associated with cranial bruit, proptosis, conjunctival swelling, and dilated arterialized conjunctival veins. Advances in the endovascular treatment of direct carotid. A followup angiogram on day 3 showed complete occlusion of the left carotid cavernous fistula with excellent crossfill at the anterior communicating artery and collateral flow to the left middle. B, left internal carotid angiogram, lateral view, showing a dural arteriovenous fistula at the posterior cavernous sinus. Carotid cavernous fistula may result from the down fracture of the maxilla or the pterygoid osteotomy, thus injuring the internal carotid artery. Pathophysiology of carotidcavernous fistulas in vascular ehlers. Carotidcavernous fistula how is carotidcavernous fistula abbreviated. Direct spontaneous carotidcavernous fistula sccf is reportedly pathognomonic of veds. We conducted this study to understand the possible mechanisms of occurrence of sccf in this subset of patients. The difference in the blood pressure between the arteries and the veins behind the eye leads to a buildup of blood in a persons eye. The carotidcavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach.
This article is from june 2005 and may contain outdated material. Carotid stenosis, carotidcavernous fistula, minimal symptom, covered stent. Carotidcavernous sinus fistulas may be dural or direct, each requiring. These aneurysms usually cause neurological symptoms due to gradual expansion without rupture. Endovascular treatment of carotid cavernous sinus fistula. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base.
Two patients had severe bilateral irregularities of caliber of both internal carotid arteries. Fractures or the shearing forces of severe head trauma. A carotid cavernous sinus fistula is an abnormal connection that forms between a carotid artery in your neck and the network of veins at the back of your eye. Carotidcavernous sinus fistula in penetrating facial trauma. Direct carotidcavernous fistulae ccfs are type a fistulae according to barrows classification. Carotid cavernous sinus fistula and aneurysmal rupture associated with fibromuscular dysplasia. We are reporting three cases of spontaneous direct carotid cavernous fistulas ccfs associated with ehlersdanlos syndrome eds out of a series of 147 direct ccfs. Discussion carotid cavernous fistulae represent a direct communication between the arterial flow of the carotid siphon and the venous compartment of the cavernous sinus 1, 2, 3. Carotidcavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. Carotidcavernous fistula ccf differential diagnoses.
The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. Treatment of carotid cavernous fistulas springerlink. Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. The treatment of a carotid cavernous fistula ccf depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. Fistulas between the cavernous sinus and the carotid artery occur either after trauma or spontaneously. Surgical exposure and direct access to the superior ophthalmic vein have been previously described in situations in which conventional transvenous access, including the inferior petrosal sinus, is not possible. But treatment success rates for these fistulas now approach 100 percent when the repairs are performed early by experienced. Treating a carotid cavernous fistula with embolization involves placing small platinum coils where the abnormal connection is. A, left external carotid angiogram, anteriorposterior view, showing shunt flow into the left cavernous sinus.
Doctor answers on symptoms, diagnosis, treatment, and more. The ocular findings in carotidcavemous fistula in a series of 17 cases. The characteristic clinical features seen in patients with ccfs are. Feb 10, 2017 these findings are consistent with a carotid cavernous fistula. Traumatic carotidcavernous sinus fistula is an uncommon situation resulting from severe trauma, with less than 40 cases having been reported.
The suspected diagnosis of a direct carotid cavernous fistula ccf was confirmed by digital substraction arteriography. Looking for online definition of carotidcavernous sinus fistula in the medical dictionary. Despite the similarity of symptoms between both types, a precise diagnosis is essential since. Spontaneous occlusion of a bilateral caroticocavernous fistula. Recent advances in endovascular techniques have resulted in several therapeutic modalities becoming available and the endovascular approach has evolved as the primary treatment option for the management of ccfs. Venous drainage patterns in carotid cavernous fistulas. Barrow classification of caroticocavernous fistulae. The present study describes a case of direct posttraumatic carotid cavernous fistula in a 26 years old man. It also provides an objective method to group the ccfs. Drainage is toward the ips and the contralateral ips through the intercavernous sinus. The treatment of the complex carotid cavernous fistula with multiple bilateral fistula points showed additional.
It is the purpose of this article to provide an overview of the anatomy of the cavernous sinus and to discuss the classification, clinical findings, diagnostic imaging evaluation, reasons for misdiagnosis, and treatment options. The diagnosis of carotidcavernous sinus fistula is based on clinical findings and must be confirmed and detailed by ct scan and arteriography. Meaning of carotidcavernous sinus fistula medical term. Aneurysms of the cavernous segment of the internal carotid artery usually become symptomatic by mass effect on the adjacent cranial nerves, causing ophthalmoplegia and, sometimes, decreased vision or trigeminal neuralgia. Treatment of carotid cavernous fistulas northwestern scholars. The internal carotid artery could be preserved in only one case. A caroticocavernous fistula ccf may be due to either a direct connection between the cavernous ica and the cavernous sinus and present acutely, or due to an indirect connection via small branches of the ica, eca, or as in this case both. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. Ccfs are classified into two main types based on their pathophysiology, direct type a and indirect type bd 1, 2, as shown in figure 1. A duct or passage resulting from injury, disease, or a congenital disorder that connects an. We conducted a retrospective analysis of a monocentric veds cohort along with a.
Carotidcavernous fistula and carotid artery aneurysm sonoworld. Highflow direct ccfs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. In this retrospective study of 20 patients, we report our. Advanced sonography of carotid arteries lecture in english.
The carotid artery, the main supply to the head, can establish a direct connection to the veins in the cavernous sinus lead to pronounced elevation of pressure in the veins which will dilate throughout the front of the head and can lead to a deadly leak. We conducted a retrospective analysis of a monocentric veds cohort along with a literature. In this light, we decided to treat this case with endovascular approach after considering several therapeutic options. This article is from march 2008 and may contain outdated material. Carotidcavernous fistula presenting with bilateral. Angle closure in carotidcavernous fistula ophthalmology. Spontaneous carotid cavernous fistula presenting only with. Spontaneous arteriovenous fistula between dural branches. Jun 25, 2018 vascular ehlersdanlos syndrome veds is a rare condition characterized by connective tissue fragility. A ccf can be due to a direct connection between the cavernous segment of. Carotid cavernous fistula due to a ruptured intracavernous. With ct, mr, and angiography, we examined 12 cases of spontaneous carotid cavernous fistula, five of whom presented only with cranial nerve palsies. Carotid cavernous fistula patients typically present with proptosis, elevated intraocular pressure, prominent tortuous conjunctival vessels, and sometimes headache. If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can eventually lead to blindness.
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