Transvenous embolization in spontaneous direct carotid-cavernous fistula in childhood

Abstract

Carotid cavernous fistula (CCF) is an abnormal arteriovenous communication in the cavernous sinus. Direct CCF results from a tear in the intracavernous carotid artery. Typically, it has a high flow and usually presents with oculo-orbital venous congestive features such as exophthalmos, chemosis, and sometimes oculomotor or abducens cranial nerve palsy. Indirect CCF generally occurs spontaneously with subtle signs. We report a rare case of spontaneous direct CCF in childhood who did not have the usual history of craniofacial trauma or connective tissue disorder but presented with progressive chemosis and exophthalmos of the right eye. This report aims also to describe the safety and success of transvenous embolization with coils of the superior ophthalmic vein and cavernous sinus through the inferior petrosal sinus.

A clinical case of carotid-cavernous fistula

“… íàñòîÿùåå âðåìÿ íà ñìåíó òàê íàçûâàåìûì îòêðûòûì âìåøàòåëüñòâàì ïðèøëè áåñêðîâíûå, îòíîñèòåëüíî ïðîñòûå ìåòîäû ýíäîâàçàëüíîé õèðóðãèè. Íàèáîëåå ýôôåêòèâíûì è áåçîïàñíûì èç íèõ ÿâëÿåòñÿ âíóòðèñîñóäèñòàÿ îêêëþçèÿ ñîóñòüÿ ñ ïîìîùüþ áàëëîíà-êàòåòåðà, çàïîëíåííîãî áûñòðîòâåðäåþùåé ìàññîé (ñèëèêîíîì), êîòîðûé ââîäÿò âî ÂÑÀ è ïðîäâèãàþò â ïîëîñòü ïåùåðèñòîãî ñèíóñà [10,11]. Ðàçäóâàÿ åãî (ôèçèîëîãè÷åñêèì ðàñòâîðîì, à ïîñëå àíãèîãðàôè÷åñêîãî êîíòðîëÿ -ïîëÿðèçóþùåé ñìåñüþ), ïëîòíî ïðèêðûâàþò èç ñèíóñà ñâèù àðòåðèè, ïðîñâåò êîòîðîé îñòàåòñÿ íåèçìåííûì.…”

A Rare Case of Direct Spontaneous Carotid-Cavernous Fistula in a 6-Month-Old Infant and Review of the Literature

“…In contrast, 38 had spontaneous fistulas, including 1 congenital fistula. Mercado et al [ 6 ] documented a 3-year-old child with direct spontaneous CCFs presenting with progressive proptosis and hyperemia; they preferred transvenous embolization for management. Nikolaev et al [ 7 ] described a 9-month-old child with direct spontaneous high-flow CCFs after nasolacrimal duct repair with left eye proptosis, conjunctival hyperemia, and vein tortuosity.…”