Carotid cavernous fistula due to a ruptured intracavernous. This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit, as depicted in the diagram below. Diagnosis and management of carotid cavernous fistulas. Dural arteriovenous fistula of the cavernous sinus with. Fistulas and sinuses of the neck and face dermnet nz. Fractures or the shearing forces of severe head trauma. The carotid cavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. Campbell, ddst the cavernous sinuses and associated structures comprise a unique and intricate physioanatomic unit. Dural arteriovenous fistulas davfs of the cavernous sinus are abnormal communications between the dural branches of the internal, or external carotid arteries, or both, and the cavernous sinus. The cavernous sinuses were symmetric and normal in size, with slightly increased flow voids in the left cavernous sinus. 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. Blind track lined by granulation tissue leading from epithelial surface down into the tissues.
Small meningeal arteries supplying dural wall of cavernous sinus can rupture spontaneously, while. It is a rare complication caused by maxillofacial trauma and can lead to amaurosis. Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Eccles health sciences library, university of utah. 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. Ccfs are classified based on hemodynamics high flow or low flow, pathogenesis spontaneous. If they do rupture they most often lead to a ccf instead of bleeding into the subarachnoid space.
Direct and indirect carotid cavernous sinus fistulas are uncommon vascular anomalies that result in increased pressure in 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. Treatment of carotid cavernous fistulas springerlink. 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 carotid cavernous sinus fistula ccf is an arterialvenous fistula between the internal carotid artery and cavernous sinus, and can be classified as either direct or indirect. If the internal carotid artery ruptures within the cavernous sinus, an arteriovenous fistula is created more specifically, a carotid cavernous fistula. Based on this classification, our case belongs to type a ii. Dural carotidcavernous sinus fistula and central retinal vein occlusion. Arteriovenous fistula definition an arteriovenous fistula is an abnormal channel or passage between an artery and a vein. This article is from march 2008 and may contain outdated material. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system.
Definition of cavernous sinus syndrome medicinenet. Young men are at highest risk, as the major cause is head trauma. The diagnosis was confirmed by digital subtraction angiography in all four instances. Surabhi sushma reddy internee mgm hospital, warangal. Carotid cavernous fistula ccf is an abnormal communication between the internal carotid artery and the cavernous sinus. It contains multiple venous channels extending from the endosteal dural layer of the sphenoid bone inferiorly and medially to the meningeal dural layer of the floor of the middle cranial fossa. 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. What is a carotid cavernous fistula doctor answers. 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. Dural cavernous sinus fistulas dcsfs represent a benign vascular disease, consisting in an arteriovenous shunt at the cavernous sinus.
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. Scanned at 2700 ppi on nikon ls2000 and nikon 8000 film scanners. Doctor answers on symptoms, diagnosis, treatment, and more. 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. 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. 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. A ccf can be due to a direct connection between the cavernous segment of.
Case presentation a 45yearold caucasian male presented to the emergency department of a tertiary care hospital with the chief complaint of blurred vision and facial numbness. What is a fistula and a sinus a fistula is an abnormal channel leading between two cavities or surfaces which may drain a fluid material such as saliva or pus. 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. These first five cta images of the head demonstrate filling of the left cavernous sinus in the arterial phase and asymmetric enlargement and filling of. The clinical presentation of ccfs, which is a direct consequence of elevation in intracavernous pressure and revised flow patterns, mostly comprises of ocular findings. Normally, oxygenated blood flows to the tissue through arteries and capillaries. Injection of coagulantcoated tiny coils into the fistula.
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. Traumatic ccf are by far the most common type, accounting for up to 75% of all ccf. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. A ptient is described with a ruptured intracavernous aneurysm causing a ccf resulting in acute onset of. The subsequent changes in blood flow lead to orbital venous congestion, cranial neuropathies, and glaucoma. A fistula latin a pipe or tube is an abnormal communication between. 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. To our knowledge, this is the first report of the ct angiographic appearance of carotidcavernous fistulas. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. Endovascular treatment strategy for direct carotid cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. Oct 17, 2008 sinuses and fistulas a sinus latin a hollow.
The difference in the blood pressure between the arteries and the veins behind the eye leads to a buildup of blood in a persons eye. If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can eventually lead to blindness. Images in clinical medicine from the new england journal of medicine carotid cavernous sinus fistula. The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3.
This article is from june 2005 and may contain outdated material. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Epileptic seizures induced by a spontaneous carotid cavernous fistula. Pathological sinuses must be distinguished from normal anatomical sinuses e. The pituitary gland lies between the two paired cavernous sinuses. 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. Caroticocavernous fistula radiology reference article.
This paper describes two cases of young men with late ccf diagnosis. Four cases in which the diagnosis of carotidcavernous fistula was made by using ct angiography are illustrated. Treatment of dural carotidcavernous sinus fistula through the superior ophthalmic veinsuperior oftalmik ven yoluyla dural. The symptoms of carotid cavernous fistula of buzzing in the ear, proptosis, and chemosis were. A carotid cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. Following the release of oxygen in the tissues, the blood returns. Oct 28, 2015 a caroticocavernous fistula results in highpressure arterial blood entering the lowpressure venous 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. In the absence of spontaneous resolution, the fistula may lead to eye redness, swelling, proptosis, chemosis, ophthalmoplegia and visual loss. 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. A carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull.
We evaluated drainage patterns of ccfs by digital subtraction angiography dsa and categorized drainage pathways according to their types and etiology. T1weighted brain mri showed left superior ophthalmic vein sov enlargement fig 1 1. Carotidcavernous fistula how is carotidcavernous fistula abbreviated. A ccf can be due to a direct connection between the. The carotidcavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. Apr 25, 2020 carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Venous drainage patterns in carotid cavernous fistulas. Ruptured cavernous sinus aneurysms causing carotid cavernous fistula.
Carotid cavernous sinus fistula closure following angiography. Conventional reconstructed mra did not reveal a fistula. Fistulous connection is within the wall of the cavernous sinus. An example would be from the mouth oral cavity to the skin surface, usually of the face or neck, and this specific type is called an orocutaneous fistula. The cavernous sinus cs is a paired dural venous sinus centered around the sella turcica. 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. A case of communicating carotidcavernous sinus fistula ccf after minor closed head injury is presented. 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. A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull.
Clinical features and differential diagnosis with mr imaging jeong hyun lee 1, ho kyu lee 1, ji kang park 2, choong gon choi 1 and dae chul suh 1 audio available share. In most instances, endovascular treatment is preferred. Direct puncture of the cavernous sinus for obliteration of a recurrent carotidcavernous fistula. Lesions affecting the cavernous sinus may affect isolated nerves or all the nerves traversing through it. Magnetic resonance angiography source images in carotid. A patient is presented who developed carotid cavernous sinus fistula 1 year after midface advancement. Carotidcavernous fistula an overview sciencedirect topics. 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.
These abnormalities can cause chemosis, proptosis, and bruit 1 and, rarely, infarction or hemorrhage. Communicating carotidcavernous sinus fistula following. It is a network of veins that sit in a cavity, approximately 1 x 2 cm in size in an adult. 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. Images in clinical medicine from the new england journal of medicine carotidcavernous sinus fistula. Intracavernous carotid artery aneurysms causing a carotid cavernous fistula ccf are rare. These aneurysms usually cause neurological symptoms due to gradual expansion without rupture. External manual carotid compression is a noninvasive method to treat cavernous sinus cs dural arteriovenous fistulae davf. Dural carotid cavernous sinus fistula and central retinal vein occlusion.
Carotidcavernous sinus fistulae ccf are extremely rare and can be classified as traumatic or spontaneous, direct when the fistula is directly off of the internal carotid artery ica or indirect when the fistula is from a branch of the ica and low or high flow. The shunting of the blood may produce ocular ischemia 503 and may transmit. Ccfs arise from abnormal connections between the carotid arteries and the cavernous sinus. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Carotid cavernous fistula joseph niamtu, iii, dds, and robert l. 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. Nursing care focused on neurological assessment, anticoagulation monitoring, maintenance of sustained elevated blood pressure bp, and gradually increased patient activity. Because of the varied and important structures within the cavernous sinus, serious pathophysiologc changes may result from trauma andor infection of this region. Cavernous sinus definition of cavernous sinus by medical. 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. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. 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. 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.
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. Cavernous region dural fistulas with venous drainage of. The carotid artery, the main supply to the head, can establish a direct connection to the veins in the cavernous sinus lead to pronounced elevation of pressure in the veins which will dilate throughout the front of the head and can lead to a deadly leak. Closure of a carotid cavernous sinus fistula occurred following angiography. Ruptured cavernous sinus aneurysms causing carotid cavernous.
Endovascular treatment strategy for direct carotidcavernous fistulas resulting from rupture of intracavernous carotid aneurysms. These lesions may be classified based on the following. Carotidcavernous fistula how is carotidcavernous fistula. Carotid cavernous 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. Carotidcavernous sinus fistula definition of carotid. Description an arteriovenous fistula is a disruption of the normal blood flow pattern. May 02, 2020 nursing care focused on neurological assessment, anticoagulation monitoring, maintenance of sustained elevated blood pressure bp, and gradually increased patient activity. Ppt carotid cavernous fistula powerpoint presentation. 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. Traumatic carotidcavernous fistula presenting as massive. Carotid cavernous sinus fistulas ccfs are abnormal communications between the carotid arterial system and the cavernous sinus.
Ccfs are classified using the barrow classification. Carotidcavernous fistula and carotid artery aneurysm. The traumatic fistulae occur more frequently, 75% of cases, appearing after car accidents or after. These abnormalities can cause chemosis, proptosis, and bruit and, rarely, infarction or hemorrhage. Ctaguided outflowtargeted embolization of direct carotidcavernous fistula duration.
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