This fistula was caused by a tear in the ica, most likely a result of the initial head trauma. Classification and treatment of spontaneous carotid. Thus, this type of avf can occur, although no case like this has been reported. 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. Endovascular treatment strategy for direct carotid cavernous fistulas resulting from rupture of intracavernous carotid aneurysms.
Classification and treatment of spontaneous carotidcavernous sinus. Left external carotid artery lateral a and left internal carotid artery lateral b digital subtraction angiogram views of an uncovered dural carotid cavernous sinus fistula which has antegrade drainage. Injection of the right ica shows a fistula in the posterior aspect of the left cavernous sinus purple, supplied by posterior hypophyseal branches red of the right meningohypophyseal trunk mht. Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. The fistula may occur spontaneously but usually occurs following. 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. Arteriovenous fistula definition an arteriovenous fistula is an abnormal channel or passage between an artery and a vein. The shunting of the blood may produce ocular ischemia 503 and may transmit arterial pulsations. Eccles health sciences library, university of utah. A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. The clinical presentation of ccfs, which is a direct consequence of elevation in intracavernous pressure and revised flow patterns, mostly comprises of ocular findings. A healthy 18yearold man was in a motor vehicle accident and received. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus.
View media gallery if the superior ophthalmic vein appears to be either asymmetric or larger than 4 mm in diameter, a carotid cavernous fistula is suggested. The carotid cavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. Carotidcavernous fistula an overview sciencedirect topics.
The vascular anomalies involving the cavernous sinus and the internal carotid artery are accordingly named carotid cavernous fistulas ccfs parkinson 1987. Pdf to describe the ocular findings, endovascular treatment, and clinical outcome in patients with dural carotid cavernous sinus fistula ccf. Type a fistulas are direct communications between the internal carotid artery ica and the cavernous sinus, usually associated with high flow. An anatomicalangiographic classification for carotid cavernous sinus fistulas is. Carotico cavernous fistula, duplex doppler, introduction carotico cavernous sinus fistula ccf is an abnormal communication between the carotid artery and the cavernous sinus and is classified angiographically as dural or direct. 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. Dural carotidcavernous sinus fistula and central retinal vein occlusion. Treatment of carotid cavernous fistulas springerlink. Four cases in which the diagnosis of carotid cavernous fistula was made by using ct angiography are illustrated. To our knowledge, this is the first report of the ct angiographic appearance of carotidcavernous fistulas.
View media gallery if the superior ophthalmic vein appears to be either asymmetric or larger than 4 mm in diameter, a carotidcavernous fistula is suggested. A paired dural venous sinus on either side of the sella turcica, the two being connected by anastomoses, the anterior and posterior intercavernous sinus, in front of and behind the hypophysis, respectively, making thus the circular sinus. Pdf carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. Endovascular treatment of carotid cavernous sinus fistula. The carotidcavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. A ccf can be due to a direct connection between the cavernous segment of. We present a rare case of carotico cavernous sinus fistula who presented with proptosis with gradual diminision of vision following a roadside accident. Spontaneous resolution of posttraumatic direct carotid. Posttraumatic carotidcavernous fistulas are due to a tear in the wall of the cavernous carotid artery, leading to shunting of blood into the cavernous sinus. We present our findings concerning the laterocavernous sinus lcs drainage of cavernous region dural fistulas, focusing our attention on the anatomy of lcs as it may have important implications in the treatment. Despite the similarity of symptoms between both types, a precise diagnosis is essential since.
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. Cavernous sinus trombosis dr munish kumar g b pant delhi 2. 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. We present a rare case of caroticocavernous sinus fistula who presented with proptosis with gradual diminision of vision following a roadside accident. Carotidcavernous fistulae are a specific kind of dural fistula that involves the carotid artery or its branches and a large vein cavernous sinus behind the eye.
Carotid cavernous fistulas are a type of arteriovenous fistula between the carotid artery and the cavernous sinus. Cavernous sinus definition of cavernous sinus by medical. Cataract extraction in a patient with carotid cavernous sinus. A carotidcavernous sinus fistula ccf is an abnormal connection between an artery in your neck and the network of veins at the back of your eye. A frontal view image fig 1 compares the normalsize right cavernous sinus with the enlarged left. Injection of coagulantcoated tiny coils into the fistula. But treatment success rates for these fistulas now approach 100. 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. Carotidcavernous sinus fistula ccf is a syndrome in which arteriovenous shunts exist between the carotid artery and the cavernous sinus. A carotid cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. These lesions may be classified based on the following. Lesions affecting the cavernous sinus may affect isolated nerves or all the nerves traversing through it. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Traumatic carotidcavernous sinus fistula with delayed. The purpose of this paper is to clarify the clinical course, with the dural carotid cavernous fistula ccf, featuring a pallet of symptoms, paying special attention to radiological findings. Carotid cavernous sinus fistula closure following angiography. They can occur posttraumatically or spontaneously and are subclassified according to whether the fistula is directly between the cavernous sinus and the ica or indirectly between the cavernous sinus and the meningeal branches of. We assumed that local maxillary sinusitis caused by dental implant might spread hematogenously into the sphenoid and cavernous sinuses and formed a carotid cavernous sinus. Images in clinical medicine from the new england journal of medicine carotidcavernous sinus fistula. Carotid cavernous fistula is an abnormal arte riovenous communication formed between carotid artery or its branches and cavernous sinus. Abstract a carotid cavernous fistula ccf is an abnormal communication between the venous cavernous sinus and the carotid artery. 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. Abstract a carotidcavernous fistula ccf is an abnormal communication between the venous cavernous sinus and the carotid artery.
Dural cavernous sinus fistulas dcsfs are benign vascular diseases consisting in an arteriovenous shunt at the cavernous sinus that if misdiagnosed can lead to potentially serious ophthalmologic complications. These veins at the back of your eye transport blood from your face and brain back to your heart and are located in small spaces behind your eyes called cavernous sinuses. Scanned at 2700 ppi on nikon ls2000 and nikon 8000 film scanners. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. A carotid cavernous sinus fistula, abbreviated as ccf, is a pathological channel which leads to the communication of the carotid artery and the cavernous sinus in the skull. Approximatelyseventyfivepercentofall ccfsare trauma related, caused by high energy injuries such as motor vehicle accidents and penetrating injuries.
The patient underwent coil embolization via both external carotid arteries. They are classified into dural cavernous sinus fistulae or direct carotidcavernous fistulae. Carotid cavernous sinus fistula ccf is an uncommon entity. Carotidcavernous sinus fistula definition of carotid. The carotid siphon of the internal carotid artery, and cranial nerves iii, iv, v branches v 1 and v 2 and vi all pass through this blood filled space nearby structures. Four cases in which the diagnosis of carotidcavernous fistula was made by using ct angiography are illustrated. Normally, oxygenated blood flows to the tissue through arteries and capillaries. Classification of cavernous sinus fistulas csfs and dural. If the internal carotid artery ruptures within the cavernous sinus, an arteriovenous fistula is created more specifically, a carotid cavernous fistula. Pdf endovascular treatment of carotid cavernous sinus fistula.
The site must be allowed 6 to 8 weeks to mature before it can be cannulated. A condition characterized by swelling of the eyelids and the conjunctivae of the eyes, as well as paralysis of the cranial nerves that course through the cavernous sinus. The potentially sightrobbing vascular abnormality known as the carotidcavernous sinus fistula ccf can masquerade as conjunctivitis or other common ocular conditions, which diminishes the chance for a speedy diagnosis. Direct, internal carotid arterytocavernous sinus fistulas should be treated with balloon occlusion of the connection between the carotid artery and cavernous sinus by an interventional neuroradiologist. This volume provides a complete guide to the diagnosis and minimal invasive treatment of. Diagnosis and management of carotid cavernous fistulas. These are often associated with a base of skull fracture.
Carotid cavernous sinus fistula caused by dental implant. Carotid cavernous sinus fistulas ccfs are abnormal communications between the carotid arterial system and the cavernous sinus. Type a fistulas are direct shunts between the internal carotid artery ica and cavernous sinus. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Type a ccfs are direct connections between the cavernous ica and the cavernous sinus. A computerized tomographic scan with contrast confined to the right orbit and cavernous sinus confirmed the presence of the fistula fig 4. Transvenous embolization of a dural carotidcavernous sinus fistula via the inferior ophthalmic vein. To our knowledge, this is the first report of the ct angiographic appearance of carotid cavernous fistulas.
Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Dural arteriovenous fistulas in the cavernous sinus. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Oct 28, 2015 ct image of the head at the level of the cavernous sinuses demonstrating left cavernous sinus widening secondary to an underlying carotid cavernous fistula. These fistulae can occur because of trauma, if there is an aneursym in the carotid that breaks and causes the communication, or they can happen spontaneously without a definite reason. Pathogenetic and therapeutic considerations of carotidcavernous. Following the release of oxygen in the tissues, the blood returns. In most instances, endovascular treatment is preferred. They are divided into direct and indirect variants per barrow classification table 1, figure 4.
The traumatic fistulae occur more frequently, 75% of cases, appearing after car accidents or after endovascular therapy. Closure of a carotid cavernous sinus fistula occurred following angiography. 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. Transvenous embolization of a dural arteriovenous fistula of the cavernous sinus through the contralateral pterygoid plexus. 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. We evaluated drainage patterns of ccfs by digital subtraction angiography dsa and categorized drainage pathways according to their types and etiology. The fistula was successfully treated angiographically.
The pituitary gland lies between the two paired cavernous sinuses. Congenital pial arteriovenous fistula in the temporal. We studied a group of patients with csdavf to identify what factors made complete resolution of their clinical symptoms and closure of the davf on magnetic resonance angiography mra by compression therapy possible. This article is from march 2008 and may contain outdated material. Posterior access to the fistula site was not feasible, so access was gained through the superior ophthalmic vein following surgical. 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. External manual carotid compression is a noninvasive method to treat cavernous sinus cs dural arteriovenous fistulae davf.
Carotid cavernous sinus fistula carotid artery cavernous sinus fistula. Artery ica or external carotid artery eca and cavernous sinus cs fig. Neurosurgery, which involves occlusion of the carotid artery both above and below the site of the fistula, may be required. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. We assumed that local maxillary sinusitis caused by dental implant might spread hematogenously into the sphenoid and cavernous sinuses and formed a carotid cavernous sinus fistula, which presented with tolosahunt syndrome. It is a network of veins that sit in a cavity, approximately 1 x 2 cm in size in an adult. Apr 25, 2020 carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Carotid cavernous sinus fistulas can result from trauma or arise spontaneously. In 1933 hamby and gardner 1 reported their observations following several surgical procedures which they employed in an attempt to bring about cure in two cases of fistula between the carotid artery and the cavernous sinus. The fistula drains primarily into the congested left superior ophthalmic vein blue, and subsequently into the angular facial veins. Fractures or the shearing forces of severe head trauma.
Early signs may be subtle, usually appearing hours to days after. 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. A retrospective analysis of 38 carotid cavernous fistula patients. Ruptured cavernous sinus aneurysms causing carotid. Cavernous region dural fistulas with venous drainage of. Cataract extraction in a patient with carotid cavernous. Caroticocavernous fistula radiology reference article. Posttraumatic causes account for 75% of direct fistulas between the internal carotid artery and the cavernous sinus.
Description an arteriovenous fistula is a disruption of the normal blood flow pattern. Carotid cavernous fistulas are abnormal connections that form between the cavernous sinus and the internal or external carotid arteries, or branches of the internal or external carotid arteries. Ruptured cavernous sinus aneurysms causing carotid cavernous. Venous drainage patterns in carotid cavernous fistulas. 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. The laterocavernous sinus lcs is a venous structure located in between the two dural layers forming the lateral wall of the cavernous sinus cs, and lcs has been described as one of the principal drainage pathways of the superficial middle cerebral vein smcv. Ct image of the head at the level of the cavernous sinuses demonstrating left cavernous sinus widening secondary to an underlying carotidcavernous fistula. Any information contained in this pdf file is automatically generated from digital. The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3.
The cavernous sinus is one of the dural venous sinuses of the head. Although previous reports of similar events have suggested that carotid artery compression, irritating and vasoconstrictor effects of radiopaque media, or embolization might explain the closure, these mechanisms seemed unlikely here. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. This article is from june 2005 and may contain outdated material. Direct puncture of the cavernous sinus for obliteration of a recurrent carotidcavernous fistula. Cavernous sinus anatomy large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone. Seventysix consecutive patients with dural ccfs were investigated in detail, all of whom were defined by angiography. 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. Contrast enhanced ct scan and angiography confiruned the diagnosis and it was managed by transfemoral embolisation of right iccf. In their case of significance in the present discussion case 2 the patient had, in the order given, ipsilateral ligation of the extracranial portion of the internal.
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. Imaging diagnosis of dural and direct cavernous carotid. Carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Ruptured cavernous sinus aneurysms causing carotid cavernous fistula. Carotid cavernous sinus fistula carotid artery cavernous.
Spontaneous ccf is a dural arteriovenous fistula at the cavernous sinus. The diagnosis was confirmed by digital subtraction angiography in all four instances. If the inline pdf is not rendering correctly, you can download the pdf file here. Dural carotid cavernous sinus fistula and central retinal vein occlusion. Similar to the carotid cavernous fistulas, a congenital pial arteriovenous fistula draining into cavernous sinus can cause bruit, proptosis, conjunctiva chemosis and symptoms referable to the optic and trigeminal nerves. Types b, c, and d ccfs are indirect connections between the cavernous sinus and branches of the ica type b, branches of the external carotid artery type c, and branches of the ica and external carotid artery type d.
493 967 684 1436 582 875 495 1308 691 464 277 631 1134 1022 1237 1563 1210 1638 938 838 1411 404 131 473 421 632 1015 709 826 853 662