A case of indirect carotid cavernous fistula presenting with proptosis and pulsatile exophthalmos

Abstract

Carotid cavernous fistulas (CCF) are abnormal arteriovenous anastomoses between the internal carotid artery (ICA) and the cavernous sinus (CS). There are two broad categories of CCFs with different clinical presentations in direct and indirect form. Internal carotid artery and the CS in the "direct" or "high flow" CCF, and branches of the internal and external carotid artery in "indirect" or "low flow" CCF are found abnormally connected. In the present case, a CCF draining into the ophthalmic vein was detected between the ICA and the CSs. An endovascular flow diverter stent was inserted, and the fistula line was closed. The complaints of the patient immediately disappeared. In CCFs, the flowing stent can completely close the fistula line in a selected patient and appropriate localization.

Cell quality evaluation with gene expression analysis of spheroids (3D) and adherent (2D) adipose stem cells

“…[6,22] Proptosis, chemosis, diplopia, ophthalmoplegia, and headache are typical symptoms of acute presentation of direct high-flow CCFs usually due to ruptured intracavernous aneurysms causing direct passage of high-pressure arterial blood into the cavernous sinus and ophthalmic vein, and consequent venous hypertension. In case of indirect CCFs, the symptoms are usually milder because of slower blood flow into the minor vessels, and they depend on the fistula drainage into the superior and/ or inferior ophthalmic veins or superior and/or IPSs; [6,19,22] symptomatic Barrow Type B CCFs are the least frequently represented among the three indirect CCF types. e goal of the treatment should be the occlusion of the fistula site or at least the reduction to minimum of the residual arterial blood flow into the venous system while preserving the patency of ICA and its arterial branches.…”

Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication?

“…Sometimes, they were reported to develop spontaneously in elderly people and women. [ 6 , 22 ] Proptosis, chemosis, diplopia, ophthalmoplegia, and headache are typical symptoms of acute presentation of direct high-flow CCFs usually due to ruptured intracavernous aneurysms causing direct passage of high-pressure arterial blood into the cavernous sinus and ophthalmic vein, and consequent venous hypertension. In case of indirect CCFs, the symptoms are usually milder because of slower blood flow into the minor vessels, and they depend on the fistula drainage into the superior and/ or inferior ophthalmic veins or superior and/or IPSs;[ 6 , 19 , 22 ] symptomatic Barrow Type B CCFs are the least frequently represented among the three indirect CCF types.…”

“…[ 6 , 22 ] Proptosis, chemosis, diplopia, ophthalmoplegia, and headache are typical symptoms of acute presentation of direct high-flow CCFs usually due to ruptured intracavernous aneurysms causing direct passage of high-pressure arterial blood into the cavernous sinus and ophthalmic vein, and consequent venous hypertension. In case of indirect CCFs, the symptoms are usually milder because of slower blood flow into the minor vessels, and they depend on the fistula drainage into the superior and/ or inferior ophthalmic veins or superior and/or IPSs;[ 6 , 19 , 22 ] symptomatic Barrow Type B CCFs are the least frequently represented among the three indirect CCF types. The goal of the treatment should be the occlusion of the fistula site or at least the reduction to minimum of the residual arterial blood flow into the venous system while preserving the patency of ICA and its arterial branches.…”

A Troublesome Case of Indirect Carotid-Cavernous Fistula Presenting with Proptosis without Pulsation

“…Hence, direct fistulas can be identified easily while indirect fistulas are frequently misdiagnosed. With the help of cerebral angiography which is the gold standard diagnostic method for CCFs [5]; the accurate diagnosis and the treatment plan with endovascular flow converting stents can be achieved in order to improve the clinical findings in appropriate cases [3].…”

“…The main symptoms of proptosis, chemosis, and orbital bruit during auscultation and ophthalmoplegia are due to progressive congestion of the venous sinuses draining into the CS. The severity of the symptoms is determined by the blood flow velocity of the shunts 3 , 4 . Hence, direct fistulas can be identified easily while indirect fistulas are frequently misdiagnosed.…”