Interventional treatment of carotid cavernous fistula

Barry, Richard C.; Wilkinson, Mark D.; Lim, Charmaine S.; Parker, Glendon J.; McCluskey, Peter; Hálmagyi, G. Michael

doi:10.1016/j.jocn.2010.12.026

Cited by 32 publications

(22 citation statements)

References 25 publications

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“…5,17,42,52,88 This is demonstrated both clinically by reversal of the signs and symptoms of the CCF and angiographically by fistula obliteration with reversal of retrograde cortical venous flow and vascular steal. In a series of more than 200 patients presenting with posttraumatic direct CCFs, Higashida et al 26 reported complete fistula occlusion with preservation of the ICA in 88% of patients.…”

Section: 48mentioning

confidence: 99%

Carotid-cavernous fistulas

Ellis¹,

Goldstein²,

Connolly³

et al. 2012

FOC

286

326

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Carotid-cavernous fistulas (CCFs) are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. The characteristic clinical features seen in patients with CCFs are the sequelae of hemodynamic dysfunction within the cavernous sinus. Once routinely treated with open surgical procedures, including carotid ligation or trapping and cavernous sinus exploration, endovascular therapy is now the treatment modality of choice in many cases. The authors provide a review of CCFs, detailing the current classification and clinical management of these lesions. Therapeutic options including conservative management, open surgery, endovascular intervention, and radiosurgical therapy are presented. The complications and treatment results as reported in the contemporary literature are also reviewed.

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Section: 48mentioning

confidence: 99%

Carotid-cavernous fistulas

Ellis¹,

Goldstein²,

Connolly³

et al. 2012

FOC

286

326

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show abstract

“…En nuestro caso se aplicó la oclusión de la arteria carótida ipsilateral con el objetivo de disminuir el flujo sanguíneo hacia la fístula, obteniéndose mejoría de los síntomas oculares. La literatura reporta una tasa de éxito de 85-90% en los casos tratados con las distintas opciones y la frecuencia de complicaciones oscila entre 5-8% (14,29). En la evolución, la disminución de la agudeza visual es el síntoma con menor recuperación debido al daño precoz de la retina y el nervio óptico, tal como ocurrió en la evolución de nuestra paciente.…”

Section: Discussionunclassified

Fistula carótido-cavernosa unilateral con síntomas neuro-oftalmológicos bilaterales e infarto cerebral venoso: Reporte de un caso.

et al. 2017

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La fistula carótido-cavernosa es una comunicación anómala entre la arteria carótida y el seno cavernoso que provoca un shunt arteriovenoso patológico y cuyo origen es traumático o espontáneo. Las manifestaciones clínicas están relacionadas con el cambio de dirección del drenaje venoso y del flujo sanguíneo a través de la fístula e incluyen síntomas oculares tales como quemosis, exoftalmos y soplo orbitario, además de manifestaciones neurológicas como infartos venosos y hemorragias intracerebrales. Su presencia se confirma mediante la angiografía por sustracción digital (ASD) y la clasificación generalmente aceptada se basa en la propuesta por Barrow. El tratamiento endovascular ha sido el enfoque terapéutico preferido durante las últimas dos décadas; sin embargo, el tratamiento quirúrgico sigue siendo una opción cuando aquél falla o no está disponible. Se reporta el caso de una paciente de 71 años de edad, con antecedente de traumatismo cráneo-encefálico en la que se diagnósticó fístula carótido-cavernosa izquierda y síntomas neuro-oftalmológicos bilaterales asociados a un infarto venoso a nivel temporal izquierdo. La paciente fue intervenida quirúrgicamente y presentó una evolución clínica favorable.PALABRAS CLAVE: Fístula del seno cavernoso de la carótida, traumatismos de las arterias carótidas, infarto cerebral, exoftalmia. SUMMARYThe carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus that induces a pathological arterio-venous shunt, and whose origin may be traumatic or spontaneous. Its clinical symptoms are related to changes in the direction of the venous drainage and blood flow through the fistula, and include ocular symptoms as chemosis, exophthalmos and orbital murmur besides neurological manifestations such as venous infarctions and intracerebral hemorrhage. Its presence is confirmed by digital subtraction angiography and the generally accepted classification is based on Barrow'se proposal. Endovascular treatment has been the preferred treatment approach for the past two decades; however, surgical treatment remains an option when the former fails or is not possible. The case of a 71 year-old woman with a history of traumatic brain injury is reported: the patient was diagnosed with carotid-cavernous fistula and bilateral neuro-ophthalmic symptoms associated with left temporal venous infarction, and underwent surgical treatment with a favorable clinical outcome.

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“…About 75% of cases have some permanent loss of visual acuity (44) . Different studies found 85-90% success rates, and complications range from 5 to 8% (death in 1%) (8,29,35) . Relapse is not uncommon (8) .…”

Section: Managementmentioning

confidence: 99%

“…Pathogenesis involves CS dilation and retrograde drainage (cortex and orbit), with increased vascular volume and enlarged orbital muscles, increased capillary transudation, elevated episcleral venous pressure, and impairment of the optic nerve and retina due to stasis. In direct CCF, these events lead to a more acute presentation with more abundant signs and symptoms (9,23,(35)(36)(37) . Indirect forms, however, have a milder or minimal presentation.…”

Section: Manifestationsmentioning

confidence: 99%