A ccf can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the. Increased pressure within the cs seems to be the mainstay of pathophysiology, although arterial steal and increased flow plays an important role. A case of communicating carotidcavernous sinus fistula ccf after minor closed head injury is presented. A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that can cause severe ocular damage. 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. Ccfs can be classified by anatomy direct or dural, etiology traumatic or sponta. Carotidcavernous fistulas are an uncommon diseases characterized by abnormal. Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus.
Endovascular treatment of carotid cavernous fistulae. In such cases it remains a challenge to find an alternative route for complete treatment. Spontaneous carotid cavernous fistula presenting only with cranial nerve palsies akira kurata,u makoto takano,1 kaichi tokiwa,1 yoshio miyasaka,1 kenzo yada,1 and shinichi kan2 purpose. However, some are iatrogenic, happening during a neurosurgical or interventional neuroradiological procedure. Endovascular treatment of carotid cavernous fistulas ccfs via a transvenous approach is standard, but in rare cases this approach is challenging due to absence or thrombosis of the commonly used venous routes. Carotidcavernous fistula as a complication of facial trauma. Caroticocavernous fistulas ccf represent abnormal communication between the carotid circulation and the cavernous sinus. 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. A study of management and outcome authors dr bharatkumar mudalgi1, dr manohar kachare2, dr manish shrivastava3, dr akshay kulkarni4 1associate professor, 2professor and head, 4senior resident department of radiodiagnosis, government medical college, miraj ms india. Carotidcavernous fistula and its surgical management. A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull.
A case of rightsided direct carotid cavernous fistula ncbi. Normally, oxygenated blood flows to the tissue through arteries and capillaries. Ccfs arise from abnormal communications between the carotid arteries and the cavernous sinus. B, left internal carotid angiogram, lateral view, showing a dural arteriovenous fistula at the posterior cavernous sinus.
Drainage is toward the ips and the contralateral ips through the intercavernous sinus. Carotid cavernous sinus fistula and aneurysmal rupture associated with fibromuscular dysplasia. To describe the etiology and clinical presentaton of carotidcavernous fistulas. Al suo interno deorrono lica e i nervi oculomotori. To discuss the differences in angiographic findings between cases of spontaneous. Arteriovenous malformation, carotidcavernous fistula, direct and indirect fistula. Mar 07, 2020 carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. May 22, 2015 sindrome del piramidal o falsa ciatica. This separates the blood flow of the carotid arteries from that of the veins. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Posttraumatic carotidcavernous fistula is a very rare complication that can occur in patients with craniomaxillofacial trauma. Nearly all patients with a direct carotid cavernous sinus fistula experience progressive ocular complications if the fistula is left untreated. Spontaneous nearcomplete resolution of direct carotid.
Ruptured cavernous sinus aneurysms causing carotid. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Meaning of carotid cavernous sinus fistula medical term. These fistulas usually result from some injury, like an automobile mishap or mugging. Fractures or the shearing forces of severe head trauma. Description an arteriovenous fistula is a disruption of the normal blood flow pattern. Treatment of carotid cavernous fistulas springerlink.
Carotid cavernous sinus fistula neuroophthalmology. Carotid cavernous sinus fistula carotid artery cavernous. A carotidcavernous 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. Caroticocavernous fistula radiology reference article. Early diagnosis of this rare vascular complication can preserve vision. Carotidcavernous sinus fistulae occur because of traumatic or spontaneous rents in the walls of the intracavernous internal carotid artery or its branches. Treating a carotid cavernous fistula with embolization involves placing small platinum coils where the abnormal connection is. With ct, mr, and angiography, we examined 12 cases of spontaneous carotid cavernous fistula, five of whom presented only with cranial nerve palsies.
T1 hypopituitarism caused by carotid cavernous fistula. Imaging diagnosis of dural and direct cavernous carotid. They are classified into dural cavernous sinus fistulae or direct carotid cavernous fistulae. Injury to the internal carotid artery causes blood to flow directly to the cavernous sinus at a higher rate than normal, resulting in redness, swelling and pain around the affected eye. It may be a result of trauma to the head, or it may develop spontaneously, particularly in middleaged women. Spontaneous carotid cavernous fistula presenting only with. A, left external carotid angiogram, anteriorposterior view, showing shunt flow into the left cavernous sinus. Oct 28, 2015 carotid cavernous fistulas ccfs are abnormal communications between the carotid arterial system and the venous 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. Carotid fistula embolization is accomplished by endovascular closure of the fistula. Advances in the endovascular treatment of direct carotid. Carotid cavernous sinus fistulas ccfs are abnormal communications between the carotid arterial system and the cavernous sinus. Ophthalmology department, pelotas federal university ufpel medical.
Fusionner pdf combiner en ligne vos fichiers pdf gratuitement. Carotidcavernous sinus fistula definition of carotid. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. Another 3 cases were subjected to the onestage operation ofhamby, i. To describe the management and outcomes in a series of 8 cases of carotid. 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. The authors report the first case of indirect carotidcavernous sinus fistula in an infant originating from the internal carotid artery. Her symptoms began abruptly with retroorbital pain, nausea, vomiting and left eye proptosis.
Clinical presentation a 42yearold patient presented with a symptomatic ccf barrow type. Craniofacial trauma is a major factor for this complication. Introduction endovascular treatment of a carotid cavernous fistula ccf via a transvenous approach is standard but, in rare cases, the standard approach is not feasible due to vessel occlusion or anomalies. Carotidcavernous fistulas ccfs are abnormal communications between the carotid arterial system and the venous cavernous sinus. A 61yearold woman presented with a symptomatic ccf with all but one of the venous access routes to the ccf thrombosed, leaving an engorged superficial middle cerebral vein. Carotid cavernous fistula ccf is the abnormal communication between the internal carotid artery and the cavernous sinus. In addition to conservative measures, carotid jugular compression at the level of the carotid bulb can be useful in the treatment of indirect fistulas resulting in closure in up to 30% of cases, presumably due to progressive thrombosis due to intermittent stagnation of blood adjacent to existing clot.
In most instances, endovascular treatment is preferred. Highflow ccfs result from a direct connection between the intracavernous carotid artery and the surrounding cavernous sinus. Indirect internal carotidcavernous fistula in infancy. This 57yearold woman with a history of migraine, hypertension and pulmonary embolism presented to an outside facility with spontaneous left ptosis, ophthalmoplaegia and headache for 4 days. Carotid cavernous fistulas ccfs are rare potentially sightthreatening abnormal connections between carotid artery and cavernous sinus. Symptoms involve headache, diplopia, ptosis of the upper lid, conjunctival chemosis, pulsating exophthalmos, and ophthalmoplegia. Pdf carotidcavernous fistula in the emergency department. Carotid cavernous fistula patients typically present with proptosis, elevated intraocular pressure, prominent tortuous conjunctival vessels, and sometimes headache. Barrow caroticocavernous fistula classification divides caroticocavernous fistulas into direct type a or indirect types bd. As a result, the blood can drain properly from the eyes. Signs and symptoms are related to the compression of structures within the cavernous sinus, including the. A sheath is placed in the femoral artery in the groin, and a catheter is used to obtain a cerebral angiogram. Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose.
Posttraumatic carotid cavernous fistula is a very rare complication that can occur in patients with craniomaxillofacial trauma. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. 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.
Most often, ccfs are broadly classified as either direct or indirect, on the basis of anatomic features depicted on angiograms. Carotidcavernous fistula an overview sciencedirect topics. The papers that were located were analyzed, focusing mainly on those related to the treatment of direct ccfs, especially the largest published series. This results in shortcircuiting of the arterial blood into the venous system of the cavernous sinuses. They can be classified as direct or indirect which are separate conditions with different etiologies. To describe the approach to endovascular treatment. Peng, md, department of neurology, yale school of medicine, 15 york st, llci 910, po box 208018, new haven, ct 06520. Carotidcavernous fistula as a complication of facial. Trauma generally triggers the development of direct carotidcavernous fistulae. Fusionner pdf combinez des fichiers pdf gratuitement en ligne. A case of communicating carotid cavernous sinus fistula ccf after minor closed head injury is presented. Ruptured cavernous sinus aneurysms causing carotid cavernous. Within the cavernous sinus, the internal carotid artery issituated between layers of the dura mater forming the sinus. Barrow classification of caroticocavernous fistulae.
Ccf is an abnormal communication between carotid arterial system internal carotid artery ica or external carotid artery eca and cavernous sinus cs fig. Endovascular treatment strategy for direct carotid cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. These lesions may be classified based on the following. In this study, we present our experience with 11 patients with ruptured cavernous sinus aneurysms causing carotid cavernous fistulas ccfs, to assess the incidence of ruptured cavernous sinus aneurysms causing ccfs and evaluate clinical presentations, treatments, and outcomes. Carotid cavernous fistulas ccfs are a rare but potentially devastating cause of orbital symptoms, visual loss, and periocular disfigurement. Hypopituitarism caused by carotid cavernous fistula. Endovascular approaches to the carotid cavernous sinus for. Carotidcavernous fistula may result from the down fracture of the maxilla or the pterygoid osteotomy, thus injuring the internal carotid artery.
A carotid cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. A carotidcavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Moreover, others arise from a spontaneous rupture of a carotid artery aneurysm in the cavernous sinus. Carotid cavernous sinus for endovascular treatment of carotid cavernous fistulas and hormone sampling akira kurata kitasato university school of medicine japan 1. A carotid cavernous sinus fistula is such a channel, that is formed between the carotid artery, one of the major arteries of the body, and the cavernous sinus, a venous sinus that lies within the head. A 45yearold caucasian male presented to the emergency department of a tertiary care. Following the release of oxygen in the tissues, the blood returns. Unlike indirect fistulas, which often have a relatively indolent course, indications for treating direct ccfs are dictated by rapidly progressive symptoms especially increased intraocular pressure and decline in vision, previous intracranial hemorrhage or epistaxis, and disabling bruit. Fistula carotido cavernosa postraumatica 270 youtube. Itsentrance into the cavernous sinus isfrequently demarcated byabandlike impression ofthe dura. Arteriovenous fistula definition an arteriovenous fistula is an abnormal channel or passage between an artery and a vein.