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Abaunza-Camacho JF, Vergara-Garcia D, Madrinan-Navia H, Riveros WM, Caballero A. Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical note. J Neurol Surg A Cent Eur Neurosurg 2022. [PMID: 35073584 DOI: 10.1055/s-0041-1741547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Indirect carotid–cavernous fistulas (iCCFs) are shunts between meningeal branches of the internal carotid and/or the external carotid arteries and the cavernous sinus. They account for 83% of all carotid–cavernous fistulas (CCFs). Symptomatic iCCFs and those with increased risk of hemorrhage should be treated. Transvenous endovascular treatment is the preferred treatment modality. However, in complex cases, a combination of transarterial and transvenous approaches (multimodal treatment) is required.
Methods A middle-aged woman presented with signs of increased intraocular pressure, blurry vision, diplopia, left proptosis, chemosis, conjunctival injection, ptosis, and cranial nerve VI palsy. Imaging confirmed the presence of a Barrow type D and Thomas type 4 iCCF with cortical venous reflux (CVR).
Results The patient underwent transarterial and transvenous onyx embolization of the shunt, achieving a complete obliteration of the fistula. No complications occurred and the patient had a satisfactory postprocedural evolution.
Conclusion Multimodal onyx embolization is an effective option for the treatment of a complex symptomatic iCCF. If CVR is identified, these lesions should be promptly treated to prevent hemorrhage secondary to rupture.
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Affiliation(s)
- Juan Felipe Abaunza-Camacho
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - David Vergara-Garcia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - Humberto Madrinan-Navia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - William Mauricio Riveros
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - Alberto Caballero
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
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Liang J, Xie X, Sun Y, Wei X, Li A. Bilateral carotid cavernous fistula after trauma: a case report and literature review. Chin Neurosurg J 2021; 7:46. [PMID: 34736536 PMCID: PMC8567609 DOI: 10.1186/s41016-021-00265-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures. The traumatic bilateral carotid cavernous fistula are significantly rarer. CASE PRESENTATIONS We report a case of a 61-year-old man presenting with unilateral exophthalmos, swollen eyelids, conjunctival congestion, and edema etiologically associated with severe trauma. Thereafter, the patient demonstrated symptoms of contralateral oculomotor nerve injury caused by skull base fracture, such as ptosis of eyelid, dilated pupils, and eye movement disorder, and was diagnosed with bilateral carotid cavernous fistula. CONCLUSIONS The patient recovered after undergoing endovascular embolization of bilateral cavernous sinus fistulas. The patient demonstrated the classic symptoms of an extremely rare condition known as bilateral carotid cavernous fistula, in only one eye. Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease.
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Affiliation(s)
- Jingshan Liang
- Department of Neurosurgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, No. 182, Tongguan Road, Lianyungang, 222000, Jiangsu, China
| | - Xiaoxiao Xie
- Department of Neurosurgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, No. 182, Tongguan Road, Lianyungang, 222000, Jiangsu, China
| | - Yong Sun
- Department of Neurointervention, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Xiuli Wei
- Department of Internal Nursing, Lianyungang Higher Vocational Technical School of Chinese Medicine, Lianyungang, China
| | - Aimin Li
- Department of Neurosurgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, No. 182, Tongguan Road, Lianyungang, 222000, Jiangsu, China.
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Efficacy of Orbital Color Doppler Imaging and Neuroimaging in the Diagnosis of Carotid Cavernous Fistulas. Ophthalmic Plast Reconstr Surg 2016; 33:340-344. [PMID: 27608286 DOI: 10.1097/iop.0000000000000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the diagnostic sensitivity and specificity of orbital color Doppler imaging (CDI) and conventional neuroimaging (CT/MRI) compared with cerebral angiography in patients with carotid-cavernous fistulas (CCFs). METHODS The study design was a retrospective patient chart and imaging review. The authors reviewed 655 charts of all patients who underwent CDI and neuroimaging (CT/MRI) between 2006 and 2015 at one institution. Sixty patients had a presumptive diagnosis of CCF without thrombosis. Thirty-seven patients with 43 events met the inclusion criteria of the study. The diagnostic sensitivity of the 3 noninvasive imaging modalities (CDI, CT, MRI) for CCF was compared with the gold standard 6-vessel cerebral angiography. Significance testing was performed using the 2-tailed Fisher test. RESULTS Color Doppler imaging had high sensitivity (96.8%) but low specificity (41.7%) for the diagnosis of CCFs with anterior orbital findings. A negative CDI had more diagnostic value than a positive CDI. While an arterial wave form in the superior ophthalmic vein was the most common finding of CCF on CDI, enlargement of the superior ophthalmic vein was the only statistically significant finding. Posterior cortical venous drainage was noted in about 10% of the patients with indirect (low-flow) fistulas, who presented with unilateral orbital signs and symptoms, a finding not previously reported in the literature. CONCLUSION Color Doppler imaging is a useful noninvasive, radiation-free modality for diagnosis of CCF with anterior drainage, with higher sensitivity than CT or MRI, but equivalent specificity. A significant limitation of CDI is the lack of usefulness in diagnosing fistulas with posterior cortical venous drainage, which carry a risk of intracerebral hemorrhage and stroke. In this series, 10% of unilateral CCFs with anterior orbital signs and symptoms showed angiographic evidence of posterior cortical venous drainage.
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Stéphan S, Blanc R, Zmuda M, Vignal C, Barral M, Pistocchi S, Piotin M, Galatoire O. Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors. J Fr Ophtalmol 2016; 39:74-81. [DOI: 10.1016/j.jfo.2015.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022]
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Carotid Cavernous Sinus Fistulas Without Superior Ophthalmic Vein Enlargement. Ophthalmic Plast Reconstr Surg 2015; 31:191-6. [DOI: 10.1097/iop.0000000000000241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pakdaman MN, Sepahdari AR, Elkhamary SM. Orbital inflammatory disease: Pictorial review and differential diagnosis. World J Radiol 2014; 6:106-115. [PMID: 24778772 PMCID: PMC4000606 DOI: 10.4329/wjr.v6.i4.106] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
Orbital inflammatory disease (OID) represents a collection of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential diagnosis including infection, systemic inflammatory conditions, and neoplasms, among other conditions. Inflammatory conditions in OID include dacryoadenitis, myositis, cellulitis, optic perineuritis, periscleritis, orbital apicitis, and a focal mass. Sclerosing orbital inflammation is a rare condition with a chronic, indolent course involving dense fibrosis and lymphocytic infiltrate. Previously thought to be along the spectrum of OID, it is now considered a distinct pathologic entity. Imaging plays an important role in elucidating any underlying etiology behind orbital inflammation and is critical for ruling out other conditions prior to a definitive diagnosis of OID. In this review, we will explore the common sites of involvement by OID and discuss differential diagnosis by site and key imaging findings for each condition.
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Venous drainage patterns in carotid cavernous fistulas. ISRN RADIOLOGY 2014; 2014:760267. [PMID: 24967298 PMCID: PMC4045554 DOI: 10.1155/2014/760267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/28/2013] [Indexed: 11/22/2022]
Abstract
Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.
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Llompart-Pou JA, Abadal JM, Pérez-Bárcena J, Homar J, Rodríguez A, Ibáñez J. Diagnóstico precoz no invasivo de la fístula carótido-cavernosa postraumática por dúplex transcraneal color. Análisis de 4 pacientes. Med Intensiva 2007; 31:46-9. [PMID: 17306140 DOI: 10.1016/s0210-5691(07)74769-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Posttraumatic carotid-cavernous fistula (PtCCF) is an uncommon complication after cranioencephalic trauma. It is usually diagnosed with a cerebral arteriography when the clinical symptoms have already appeared. The transcranial color-coded duplex sonography (TCDS) is a non-invasive technique at the patient's bedside that permits visualization of the circle of Willis and the intracavernous segment of the internal carotid artery. The initial sonographic patterns that suggest the presence of a PtCCF by TCDS are a mosaic image in color mode, presence of arterial and venous flows mixed with high velocity and low resistances. We present our experience in the early and non-invasive diagnosis of PtCFF in an Intensive Care Unit.
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Affiliation(s)
- J A Llompart-Pou
- Servicio de Medicina Intensiva, Hospital Universitario Son Dureta, Palma de Mallorca, España.
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Ray CE, Spalding SC, Cothren CC, Wang WS, Moore EE, Johnson SP. State of the art: noninvasive imaging and management of neurovascular trauma. World J Emerg Surg 2007; 2:1. [PMID: 17212833 PMCID: PMC1796545 DOI: 10.1186/1749-7922-2-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 01/09/2007] [Indexed: 11/10/2022] Open
Abstract
Neurotrauma represents a significant public health problem, accounting for a significant proportion of the morbidity and mortality associated with all traumatic injuries. Both blunt and penetrating injuries to cervicocerebral vessels are significant and are likely more common than previously recognized. Imaging of such injuries is an important component in the evaluation of individuals presenting with such potential injuries, made all the more important since many of the vascular injuries are clinically silent. Management of injuries, particularly those caused by blunt trauma, is constantly evolving. This article addresses the current state of imaging and treatment of such injuries.
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Affiliation(s)
- Charles E Ray
- Diagnostic and Interventional Radiology, Denver Health Medical Center, 777 Bannock St, Denver, CO80204, USA
- Diagnostic and Interventional Radiology, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - Shaun C Spalding
- Diagnostic and Interventional Radiology, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - C Clay Cothren
- Surgery, Denver Health Medical Center, 777 Bannock St., Denver, CO80204, USA
- Surgery, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - Wei-Shin Wang
- University of Colorado School of Medicine, 4200 East Ninth Street, Denver, CO80220, USA
| | - Ernest E Moore
- Surgery, Denver Health Medical Center, 777 Bannock St., Denver, CO80204, USA
- Surgery, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - Stephen P Johnson
- Diagnostic and Interventional Radiology, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
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Casares-Vivas M, Miralvés-Celma S, Pérez-Báecena J, Abadal-Centellas JM, Homar-Ramírez J. Diagnóstico por dúplex transcraneal color de una fístula carótido-cavernosa traumática. Neurocirugia (Astur) 2004; 15:388-90. [PMID: 15368031 DOI: 10.1016/s1130-1473(04)70475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The extracranial carotid duplex is a feasible, non invasive technique that is useful for the diagnosis of some intracranial pathologies. We present the case of a patient who was admitted in our unit with a severe traumatic brain injury. An early transcranial color duplex showed a mosaic color flash with unidirectional turbulent flow that was compatible with a posttraumatic carotid cavernous fistula that was confirmed by angio MRI.
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Affiliation(s)
- M Casares-Vivas
- Servicio de Medicina Intensiva, Hospital Universitario Son Dureta, Palma de Mallorca
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