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Tsuji K, Tsuji A, Yoshimura Y, Kawano H, Fujisawa R, Nozaki K. Brainstem Venous Congestion Due to Transverse-sigmoid Sinus Dural Arteriovenous Fistula: Case Report and Literature Review. NMC Case Rep J 2022; 8:617-623. [PMID: 35079525 PMCID: PMC8769469 DOI: 10.2176/nmccrj.cr.2020-0433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/13/2021] [Indexed: 11/20/2022] Open
Abstract
Brainstem venous congestion due to dural arteriovenous fistula (dAVF) can mimic brainstem glioma and infarction. We report a case of a 56-year-old woman with a transverse-sigmoid sinus (TS) dAVF. On MRI, she presented with brainstem edema that was difficult to distinguish from brainstem glioma and infarction. She was referred to our hospital for mild dysarthria with right hemiparesis and a suspected left pontine glioma. On MRI, contrast enhancement of the lesion was demarcated by the pontine raphe, and the ipsilateral vein of Rosenthal was dilated. Cerebral angiography revealed TS dAVF with an isolated sinus. Transarterial followed by transvenous coil embolization was performed to reduce shunt flow, resulting in symptom improvement and normal findings on MRI and cerebral angiography. Brainstem venous congestion due to TS dAVF is as rare as adult brainstem glioma. Differentiating the above-mentioned three diseases on the basis of diagnostic imaging findings and clinical course is necessary for appropriate and timely treatment.
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Affiliation(s)
- Keiichi Tsuji
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Atsushi Tsuji
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yayoi Yoshimura
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroto Kawano
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Ryo Fujisawa
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Hou K, Li G, Qu L, Liu H, Xu K, Yu J. Intracranial Dural Arteriovenous Fistulas With Brainstem Engorgement: An Under-Recognized Entity in Diagnosis and Treatment. Front Neurol 2020; 11:526550. [PMID: 33101168 PMCID: PMC7546322 DOI: 10.3389/fneur.2020.526550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/28/2020] [Indexed: 12/26/2022] Open
Abstract
Background: In rare circumstances, patients with intracranial (dural arteriovenous fistulas) DAVFs could be complicated with brainstem engorgement, which might lead to delayed or false diagnosis and subsequent improper management. Methods: On July 2th, 2019, a systematic search was conducted in the PubMed database for patients with intracranial DAVFs complicated with brainstem engorgement. Results: Sixty-eight articles reporting of 86 patients were included for final analysis. The patients were aged from 20 to 76 years (57.10 ± 12.90, n = 82). The female to male ratio was 0.68 (35:51). Thirty-three (40.2%, 33/82) patients were initially misdiagnosed as other diseases. The specific location distributions were cranio-cervical junction, cavernous sinus, superior petrosal sinus, transverse and/or sigmoid sinus, tentorium, and other sites in 27 (32.5%), 11 (13.2%), 9 (10.8%), 10 (12.0%), 21 (25.3%), and 5 (6.0%) patients, respectively. The Cognard classification of DAVFs were II, III, IV, and V in 9 (10.7%, 9/84), 1 (1.2%, 1/84), 1 (1.2%, 1/84), and 73 (86.9%, 73/84) patients. Eighteen (22%, 18/82) patients were demonstrated to have stenosis or occlusion of the draining system distal to the fistula points. The mean follow-up period was 7.86 (n = 74, range 0–60 months) months. Fifty-four (70.1%, 54/77) patients experienced a good recovery according to the mRS score. Conclusions: Intracranial DAVFs complicated with brainstem engorgement are rare entities. Initial misdiagnosis and delayed definite diagnosis are common in the past three decades. The treatment outcome is still unsatisfactory at present. Early awareness of this rare entity and efficiently utilizing the up to date investigations are of utmost importance.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Lai Qu
- Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Hongping Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula. Case Rep Neurol Med 2020; 2020:2630959. [PMID: 32547797 PMCID: PMC7271059 DOI: 10.1155/2020/2630959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.
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Iampreechakul P, Wangtanaphat K, Lertbutsayanukul P, Wattanasen Y, Siriwimonmas S. Spontaneous Closure of a Cavernous Sinus Dural Arteriovenous Fistula with Spinal Perimedullary Drainage (Cognard V) during Attempted Transvenous Embolization. Asian J Neurosurg 2020; 14:1268-1274. [PMID: 31903376 PMCID: PMC6896619 DOI: 10.4103/ajns.ajns_277_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The authors describe a patient with spontaneous closure of a spontaneous cavernous sinus dural arteriovenous fistula (CSDAVF), Cognard type V, during transvenous attempt. A 39-year-old woman experienced mild proptosis, redness of the left eye, and diplopia. Four months later, she developed left retro-orbital pain and left-sided headache. Cerebral angiography revealed the left CSDAVF exclusively draining into the superior petrosal sinus with subsequent drainage into the veins surrounding the medulla oblongata, and finally into the perimedullary spinal veins, classified as Cognard type V. The feeders arise from the dural branches of both the left external and internal carotid arteries. Following 2 h period of attempted transvenous embolization, the fistula disappeared spontaneously. Follow-up angiography obtained 6 months later confirmed complete resolution of the CSDAVF. At 2-year follow-up, the patient has remained clinically asymptomatic. The mechanism of thrombosis in this fistula related to the endovascular procedure. We speculated that putting the wire tip in the draining vein may induce the spontaneous thrombosis in the venous side. In addition, precipitating factors may include small, low-flow fistula, and pre-existing thrombosis.
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Affiliation(s)
| | | | | | - Yodkhwan Wattanasen
- Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
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5
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Abstract
Blunt cerebrovascular injury (BCVI) is a relatively rare but potentially devastating finding in patients with high-energy blunt force trauma or direct cervical and/or craniofacial injury. The radiologist plays an essential role in identifying and grading the various types of vascular injury, including minimal intimal injury, dissection with raised intimal flap or intraluminal thrombus, intramural hematoma, pseudoaneurysm, occlusion, transection, and arteriovenous fistula. Early identification of BCVI is important, as treatment with antithrombotic therapy has been shown to reduce the incidence of postinjury ischemic stroke. Patients with specific mechanisms of injury, particular imaging findings, or certain clinical signs and symptoms have been identified as appropriate and cost-effective for BCVI screening. Although digital subtraction angiography was previously considered the standard examination for screening, technologic improvements have led to its replacement with computed tomographic angiography. Of note, although not appropriate for screening, improvements in magnetic resonance angiography with vessel wall imaging hold promise as supplemental imaging studies that may improve diagnostic specificity for vessel wall injuries. Understanding the screening criteria, imaging modalities of choice, imaging appearances, and grading of BCVI is essential for the radiologist to ensure fast and appropriate diagnosis and treatment. This article details the imaging evaluation of BCVI and discusses the clinical and follow-up imaging implications of specific injury findings. ©RSNA, 2018.
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Affiliation(s)
- Aaron M Rutman
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195
| | - Justin E Vranic
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195
| | - Mahmud Mossa-Basha
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195
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6
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Chan FH, Shen CY, Liu JT, Li CS. Brainstem hemorrhage caused by direct carotid-cavernous fistula. A case report and literature review. Interv Neuroradiol 2014; 20:487-94. [PMID: 25207913 DOI: 10.15274/inr-2014-10038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/20/2014] [Indexed: 11/12/2022] Open
Abstract
A 34-year-old woman presented with a history of persisting headache for years, and a newly developed dizziness, left facial palsy and right hemiparesis two days prior to this admission. Initial computed tomographic angiography of the head demonstrated an area of increased density in the left middle and posterior fossae. Multiple aneurysmally dilated venous ectasias with contrast enhancement at the left pre-pontine cistern causing a massive mass effect to the brainstem were also noted, suggesting a huge vascular abnormality. Digital subtraction angiography revealed an abnormal vascular lesion surrounding the brainstem, which indicated a left direct carotid-cavernous fistula with posterior drainage. As her consciousness deteriorated the next day, a follow-up computed tomography scan was done which revealed a pontine hemorrhage. Subsequently, endovascular closure of the fistula with sacrifice of the left ICA was performed, which successfully eliminated the imaging abnormalities.
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Affiliation(s)
- Fook-How Chan
- Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan -
| | - Chao-Yu Shen
- Department of Medical Imaging, School of Medical Imaging and Radiological Sciences, - School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan
| | - Jung-Tung Liu
- Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan
| | - Cho-Shun Li
- Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan
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7
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Wu Q, Wang HD, Shin YS, Zhang X. Brainstem Congestion due to Dural Ateriovenous Fistula at the Craniocervical Junction. J Korean Neurosurg Soc 2014; 55:152-5. [PMID: 24851151 PMCID: PMC4024815 DOI: 10.3340/jkns.2014.55.3.152] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 06/17/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022] Open
Abstract
Dural ateriovenous fistula (DAVF) at the craniocervical junction is rare. We report a patient presenting with brainstem dysfunction as an uncommon onset. Brainstem lesion was suggested by magnetic resonance image study. Angiogram revealed a DAVF at a high cervical segment supplied by the meningeal branch of the right vertebral artery, with ascending and descending venous drainage. Complete obliteration of the fistula was achieved via transarterial Onyx embolization. Clinical cure was achieved in the follow-up period; meanwhile, imaging abnormalities of this case disappeared. Accordingly, we hypothesize that a brainstem lesion of this case was caused by craniocervical DAVF, which induced venous hypertension. Thus, venous drainage patterns should be paid attention to because they are important for diagnosis and theraputic strategy.
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Affiliation(s)
- Qi Wu
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Han-Dong Wang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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Miyagishima T, Hara T, Inoue M, Terano N, Ohno H, Okamoto K, Hasuo K. Pontine venous congestion due to dural arteriovenous fistula of the cavernous sinus: Case report and review of the literature. Surg Neurol Int 2012; 3:53. [PMID: 22629490 PMCID: PMC3356981 DOI: 10.4103/2152-7806.96076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 04/09/2012] [Indexed: 11/04/2022] Open
Abstract
Background: We report herein a case of cavernous sinus (CS)-dural arteriovenous fistula (DAVF) with brainstem venous congestion that was successfully treated by transarterial embolization, followed by radiotherapy. Case Description: An 80-year-old woman presented with right eye chemosis and left hemiparesis. T2-weighted magnetic resonance imaging showed hyperintensity of the pons. Diagnostic cerebral angiography demonstrated CS-DAVF draining into the right superior orbital vein and petrosal vein, and fed by bilateral internal and external carotid arteries. Transarterial embolization was performed and followed by radiotherapy, resulting in resolution of the pontine lesion and neurological and ophthalmological symptoms within 5 months. Conclusions: We also review the literature regarding therapy for CS-DAVF with brainstem venous congestion. Once CS-DAVF with venous congestion of the brainstem has been definitively diagnosed, immediate therapy is warranted. Treatment with transarterial embolization followed by radiation may be an important option for elderly patients when transvenous or transarterial embolization is not an option.
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Affiliation(s)
- Takaaki Miyagishima
- Department of Neurosurgery, National Center for Global Health and Medicine, Gunma, Japan
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9
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Miller NR. Dural Carotid-Cavernous Fistulas: Epidemiology, Clinical Presentation, and Management. Neurosurg Clin N Am 2012; 23:179-92. [DOI: 10.1016/j.nec.2011.09.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Aldea S, Guedin P, Roccatagliata L, Boulin A, Auliac S, Dupuy M, Cerf C, Gaillard S, Rodesch G. Controlateral cavernous syndrome, brainstem congestion and posterior fossa venous thrombosis with cerebellar hematoma related to a ruptured intracavernous carotid artery aneurysm. Acta Neurochir (Wien) 2011; 153:1297-302. [PMID: 21380852 DOI: 10.1007/s00701-011-0982-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 02/17/2011] [Indexed: 11/25/2022]
Abstract
Intracavernous carotid artery aneurysms (ICCAs) are rarely associated with life-threatening complications. We describe a 55-year-old woman who, after the rupture of an intracavernous carotid artery aneurysm, presented with a contralateral cavernous sinus syndrome and severe posterior fossa and spinal cord symptoms. Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a "locked-in" state. The patient fully recovered with anticoagulation therapy. Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications related to venous thrombosis.
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Affiliation(s)
- Sorin Aldea
- Department of Neurosurgery, Hopital Foch, Suresnes, France.
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11
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Ito Y, Sanjo N, Ishikawa K, Tao O, Yokota T, Mizusawa H. Brainstem congestion due to carotid-cavernous fistula via a shunt from the external carotid artery. J Neurol 2011; 258:2288-90. [PMID: 21607720 DOI: 10.1007/s00415-011-6102-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/10/2011] [Indexed: 11/28/2022]
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12
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Gierthmuehlen M, Schumacher M, Zentner J, Hader C. Brainstem compression caused by bilateral traumatic carotid cavernous fistulas: case report. Neurosurgery 2011; 67:E1160-3; discussion E1163-4. [PMID: 20881535 DOI: 10.1227/neu.0b013e3181edb148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bilateral traumatic carotid cavernous fistulas (CCFs) are rare and may dilate the cavernous sinus. We present a case of brainstem compression caused by a cavernous sinus dilated by the arterial pressure of bilateral CCF. CLINICAL PRESENTATION A 30-year-old man suffered severe head trauma in a motorbike accident. Hemodynamically relevant, untreatable epistaxis required angiography, which revealed acute bleeding of the left sphenopalatine artery and bilateral traumatic CCFs. The bleeding was stopped by embolization with particles, and the left CCF was partially embolized to stabilize the patient hemodynamically. After short-term treatment and a long clinical course, the patient was referred to rehabilitation. Three months after trauma, the patient presented with severe headache and a dilated right pupil; he was somnolent. Immediate cerebral computed tomography scan showed a retroclival mass compressing the brainstem. Digital subtraction angiography revealed a reperfused left-sided CCF causing a huge dilatation of the retroclival cavernous sinus. After embolization with 2 balloons, the symptoms resolved and the patient was readmitted to rehabilitation. CONCLUSION Bilateral traumatic CCFs are uncommon. Brainstem impairment caused by venous congestion and consecutive edema is an extremely rare complication of CCFs, with only a few cases reported in the literature. Direct compression of the brainstem by CCFs has, to the best of our knowledge, never been reported before. Immediate endovascular intervention led to complete remission of the symptoms.
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13
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Ko SB, Kim CK, Lee SH, Yoon BW. Carotid cavernous fistula with cervical myelopathy. J Clin Neurosci 2009; 16:1350-3. [DOI: 10.1016/j.jocn.2008.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 12/16/2008] [Indexed: 10/20/2022]
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14
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15
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Liang W, Xiaofeng Y, Weiguo L, Desheng P, Gang S, Xuesheng Z, Xiaoyan X, Dingyao J. Bilateral traumatic carotid cavernous fistula: the manifestations, transvascular embolization and prevention of the vascular complications after therapeutic embolization. J Craniofac Surg 2007; 18:74-7. [PMID: 17251840 DOI: 10.1097/01.scs.0000231629.18135.cd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bilateral traumatic carotid cavernous fistula is very rare after traumatic brain and facial injury. We present a 68-year-old woman with bilateral traumatic carotid cavernous fistula, who was treated with transarterial embolization by detachable balloon on both fistulas and recovered completely. We also reviewed the presentations, treatment and the complications after the transarterial embolization of this disorder.
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Affiliation(s)
- Wen Liang
- Neurosurgery Department, Second Affiliated Hospital, Zhejiang University, College of Medicine, Hangzhou, China
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16
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Blanco Cabellos JA, González Ortega S, Sonlleva Ayuso A, López Lafuente J, Alvarez-Cortinas JF. Fístulas carótido-cavernosas. A propósito de dos casos. RADIOLOGIA 2007; 49:121-4. [PMID: 17403342 DOI: 10.1016/s0033-8338(07)73732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Carotid-cavernous fistulas are uncommon anomalous communications between the venous cavernous sinus and the carotid arterial system. We present two cases studied at our center. We show the characteristic CT, MRI, and orbital ultrasound findings and review the relevant literature.
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Affiliation(s)
- J A Blanco Cabellos
- Servicio de Diagnóstico por imagen, Fundación Hospital Alcorcón, Alcorcón, Madrid, España.
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17
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Murata H, Kubota T, Murai M, Kanno H, Fujii S, Yamamoto I. Brainstem congestion caused by direct carotid-cavernous fistula--case report. Neurol Med Chir (Tokyo) 2003; 43:255-8. [PMID: 12790286 DOI: 10.2176/nmc.43.255] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 41-year-old woman presented with tinnitus in the left ear and headache, followed by diplopia and pain in the left cheek. Angiography showed a left high-flow direct carotid-cavernous fistula (CCF), causing steal of the blood flow from the internal carotid artery into the cavernous sinus. A few days later, she rapidly developed right hemiparesis, dysarthria, and ocular conjugate deviation to the right, and became somnolent. Angiography at that time revealed occlusion of the superior petrosal sinus, causing engorgement of the veins in the surrounding brainstem. The CCF was completely embolized with interlocking detachable coils. Her consciousness disturbance and ophthalmoparesis dramatically improved within a few days, and the right hemiparesis and dysarthria gradually resolved. Magnetic resonance (MR) imaging after the treatment showed small pontine hemorrhage and perifocal edema but no ischemic lesions in the cerebral hemisphere. Re-evaluation of the MR imaging with gadolinium taken on admission demonstrated engorged veins in the brainstem parenchyma, which corresponded to the hemorrhagic lesion in the brainstem. Brainstem congestion caused by direct CCF is very rare, but it can be life-threatening. Good outcome can be expected if the CCF is completely occluded before congestive hemorrhage occurs.
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Affiliation(s)
- Hidetoshi Murata
- Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan.
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18
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Fattahi TT, Brandt MT, Jenkins WS, Steinberg B. Traumatic carotid-cavernous fistula: pathophysiology and treatment. J Craniofac Surg 2003; 14:240-6. [PMID: 12621297 DOI: 10.1097/00001665-200303000-00020] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traumatic carotid-cavernous fistulae are rare yet potentially lethal vascular anomalies in the skull base seen after craniomaxillofacial trauma. This aberrant vascular communication has been extensively evaluated and classified, with a number of treatment modalities available to clinicians. The ultimate and definitive treatment of carotid-cavernous fistulae falls beyond the scope of craniomaxillofacial surgery. Nevertheless, clinicians treating patients with craniofacial injuries should have a complete understanding of this pathological entity, because urgent intervention may improve patient outcome.
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Affiliation(s)
- Tirbod T Fattahi
- Division of Maxillofacial Surgery, Department of Surgery, University of Florida-Jacksonville, 32209, USA.
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19
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Rucker JC, Newman NJ. Diffuse dural enhancement in cavernous sinus dural arteriovenous fistula. Neuroradiology 2003; 45:88-9. [PMID: 12592490 DOI: 10.1007/s00234-002-0920-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2002] [Accepted: 11/04/2002] [Indexed: 11/30/2022]
Abstract
We describe unusually extensive contrast enhancement of the dura mater on MRI in a case of dural arteriovenous fistula of the cavernous sinus.
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Affiliation(s)
- J C Rucker
- Neuro-ophthalmology Unit, Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, 1365-B Clifton Road, Atlanta GA 30322, USA
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