Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

Pashapour, Ali; Mohammadian, Reza; Salehpour, Firooz; Sharifipour, Ehsan; Mansourizade, Reza; Mahdavifard, Ali; Salehi, Mohamadgharib; Mirzaii, Farhad; Sariaslani, Payam; Ardalani, Ghasem Fatahzade; Altafi, Davar

doi:10.15274/nrj-2014-10079

Cited by 22 publications

(24 citation statements)

References 34 publications

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“…1,26 Presenting symptoms of CCFs may include a subjective bruit, diplopia, tearing, red eye, ocular foreign body sensation, blurred vision, and headache. 1,[27][28][29][30][31] Anteriorly draining fistulas are more likely to cause ocular symptoms. 22 Patients with posteriorly draining fistulas may develop neurologic symptoms, such as confusion and expressive aphasia, 32 as well as diplopia from isolated ocular motor nerve pareses.…”

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“…57 Some authors report a high rate of success when transarterial embolization using acrylic glue is performed as the primary approach to dural fistulas. 31 Compared with glue, Onyx is more cohesive and polymerizes more slowly. These characteristics allow the neurointerventionalist to inject slowly or even discontinuously into the cavernous sinus, thus resulting in improved accuracy and reducing the need for repeated catheterizations.…”

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confidence: 99%

“…64 The success rate for transvenous procedures is~80%, albeit with a centre-dependent complication rate that ranges up to 20%. 19,31,61,65,66 Reported complications include ocular motor nerve palsies; trigeminal sensory neuropathy; brainstem infarction; significant IOP elevation; intracranial haemorrhage; pulmonary emboli; and orbital haemorrhage in the setting of the SOV or inferior ophthalmic vein approach. 61,[65][66][67][68] In addition, a case of inappropriate antidiuretic hormone secretion (SIADH) has been reported, which the authors attributed to disruption of posterior pituitary blood supply by the Onyx used for embolization.…”

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Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Henderson

Miller

2017

Eye

197

232

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A carotid-cavernous fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as either direct or dural. Direct CCFs are characterized by a direct connection between the internal carotid artery (ICA) and the cavernous sinus, whereas dural CCFs result from an indirect connection involving cavernous arterial branches and the cavernous sinus. Direct CCFs frequently are traumatic in origin and also may be caused by rupture of an ICA aneurysm within the cavernous sinus, Ehlers-Danlos syndrome type IV, or iatrogenic intervention. Causes of dural CCFs include hypertension, fibromuscular dysplasia, Ehlers-Danlos type IV, and dissection of the ICA. Evaluation of a suspected CCF often involves non-invasive imaging techniques, including standard tonometry, pneumotonometry, ultrasound, computed tomographic scanning and angiography, and/or magnetic resonance imaging and angiography, but the gold standard for classification and diagnosis remains digital subtraction angiography. When a direct CCF is confirmed, first-line treatment is endovascular intervention, which may be accomplished using detachable balloons, coils, liquid embolic agents, or a combination of these tools. As dural CCFs often resolve spontaneously, low-risk cases may be managed conservatively. When invasive treatment is warranted, endovascular intervention or stereotactic radiosurgery may be performed. Modern endovascular techniques offer the ability to successfully treat CCFs with a low morbidity and virtually no mortality.

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Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Henderson

Miller

2017

Eye

197

232

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“…Основним методом лікування хворих з ККС є ендоваскулярне виключення співустя за допомогою різних методів: балон-катетерів, спіралей, використання рідких тромбуючих речовин [5][6][7].…”

Section: після операції дуральне каротидно-кавернозне співустя зліваunclassified

Клинический Случай Эндоваскулярного Выключения Дурального Каротидно-Кавернозного Соустья Трансвенозным Трансорбитальным Доступом

Петренко¹,

Egorova²,

Lugovskyy³

et al. 2021

AOU

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Представлен клинический случай эндоваскулярного выключения дурального каротидно-кавернозного соустья (ККС) трансвенозным трансорбитальным доступом. ККС — сложная патология сосудов головного мозга, при которой происходит формирование аномального шунтирования артериальной крови в кавернозный синус. Повышение давления в венозном синусе до уровня, который превышает венозное давление и достигает артериального давления, приводит к застойным явлениям в структурах, от которых оттекает венозная кровь в кавернозный синус в норме. Первый симптом заболевания — пульсирующий шум в височной области, наблюдается у большинства больных с ККС. Независимо от источника кровоснабжения ККС офтальмологическая симптоматика представлена признаками нарушения венозного оттока от глаза и орбиты. В клинической картине заболевания преобладает офтальмологическая симптоматика: экзофтальм, застойная инъекция глазного яблока, отек век, хемоз, глазодвигательные нарушения, офтальмогипертензия. Прогноз спонтанного течения заболевания при ККС неблагоприятен. Выздоровление происходит в 5–10 % случаев, летальность до 15 % от внутричерепного кровотечения, 50–60 % больных инвалидизированы вследствие потери зрения и психических нарушений. Основным методом лечения больных с ККС является эндоваскулярное выключение соустья из кровотока при помощи разных методов: баллон-катетеров, спиралей, использования жидких тромбирующих веществ. Венозный подход проводят через внутреннюю яремную вену и нижний каменистый синус (НКС). В случае тромбированного НКС катетеризация не всегда возможна. В связи с этим выполнение прямой хирургической пункции верхней глазной вены может быть методом выбора. Представленный клинический случай демонстрирует разобщение соустья путем имплантации спиралей трансвенозным трансорбитальным доступом через верхнюю глазную вену при невозможности проведения традиционного эндоваскулярного трансвенозного подхода через внутреннюю яремную вену и НКС. При проведении контрольной церебральной ангиографии, через 3 месяца, признаков патологического кровотока в области кавернозного синуса не выявлено. Клинический случай свидетельствует о важности ранней диагностики для своевременного выключения соустья из кровотока с целью сохранения функции зрения. Применение трансвенозного доступа через верхнюю глазную вену выполнено впервые в Украине.

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“…Such clinical manifestations and signs are usually moderate to extreme, and at first life threatening, because the shunt is still high in flow and pressure. [2][3][4] Manual carotid artery compression in some patients has been shown to be effective. 5 TCCF can cause morbidity, especially when combined with retrograde cortical venous drainage, including blindness, seizure, stroke, and intracranial hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

<p>Neuro-Endovascular Intervention in Traumatic Carotico-Cavernous Fistulae: A Single-Center Experience</p>

Arifin¹,

Akbar²,

Illyasa³

et al. 2020

IJGM

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The aim of this research was to describe a single-center practical experience in the management of traumatic carotid cavernous fistula (CCF). Methods: There were a total of 31 patients between January 2005 and December 2019 with post-traumatic carotid cavernous sinus fistula (tCCF) who underwent treatment. We classified them into 2 types according to the flow of the CCF: patients with high flow CCF and patients with low flow CCF. Results: Angiography revealed the high flow types on 21 patients (67.7%), the mean of patients ages are 31.5 years. Onyx embolization was performed in 1 patient (4.76%), transarterial balloon embolization was carried out in 10 patients (47.61%), transarterial coiling in 3 (14.28%) patients while 5 (28.8%) patients underwent transvenous routes to insert the coil and 2 patients (9.52%) were treated conservatively. Complete occlusion was achieved on all patients with coiling whereas the other treatment experiences the reducing flow of the fistula. We obtained 10 patients (32.2%) with a mean of 40.3 years as low flow type CCF. The patients with the low flow type mostly treated conservatively, because their symptoms were acceptable and intermittent. Conclusion: The ballooning currently became the more affordable treatment in our center. Balloon embolization was recommended for medium-and large-size fistula. The coils should be recommended for small-size fistula. In some cases occlusion of the fistula cannot be obtained using the detachable balloon, a coil can be used to occlude the cavernous sinus via trans arterial or trans venous access. If the fistula failed to be treated in traditional ways using balloons or coils, occlusion of the parent vessels could be another option.

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Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

Abstract: SUMMARY -Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF).

Cited by 22 publications

References 34 publications

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Клинический Случай Эндоваскулярного Выключения Дурального Каротидно-Кавернозного Соустья Трансвенозным Трансорбитальным Доступом

<p>Neuro-Endovascular Intervention in Traumatic Carotico-Cavernous Fistulae: A Single-Center Experience</p>

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