Get a printable copy pdf file of the complete article 2. Carotidcavernous fistula an overview sciencedirect topics. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. Carotid cavernous fistulas can be first classified by whether they are traumatic including iatrogenic or spontaneous. In the event that the balloon cannot be fed through the fistula via a transarterial approach, detachable platinum coils are often deployed electrolytically via a. The traumatic fistulae occur more frequently, 75% of cases, appearing after car accidents or after. Craniofacial trauma is a major factor for this complication. 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. External manual carotid compression is a noninvasive method to treat cavernous sinus cs dural arteriovenous fistulae davf. Feb 10, 2017 the fistula was supplied most prominently from the bilateral external carotid arteries and showed prominent retrograde drainage into the dilated left superior ophthalmic vein. This frontal view shows the enlarged left carotid cavernous sinus fistula right compared to the normal right cavernous sinus left. Treatment of carotid cavernous fistulas northwestern scholars.
A ccf can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external. A carotidcavernous fistula ccf is an abnormal communication between the carotid artery and the cavernous sinus, which is characterized by increased episcleral venous pressure and decreased arterial blood flow to the cranial nerves within the cavernous sinus. What is a carotid cavernous fistula doctor answers. Spontaneous carotidcavernous fistula and the ehlersdanlos syndromes. 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.
A carotid cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit, as depicted in the diagram below. The coils also might exert mass effect and result in cranial nerve injury. Carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. 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. 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. Full text full text is available as a scanned copy of the original print version.
If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can. Ruptured cavernous sinus aneurysms causing carotid cavernous. The shunting of the blood may produce ocular ischemia 503 and may transmit. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. Four cases in which the diagnosis of carotid cavernous fistula was made by using ct angiography are illustrated. Carotidcavernous sinus fistula in penetrating facial trauma. Highflow direct ccfs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a. 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. Carotid cavernous fistula adventhealth neuroscience.
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. The carotid cavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. Early diagnosis of this rare vascular complication can preserve vision. The classic signs of a carotidcavernous fistula, including sudden onset of pulsating exophthalmos, a prominent bruit behind the affected eye, marked venous congestion and chemosis, impaired eye movement, and reduced visual acuity were present only in the patient with a traumatic direct internal carotidcavernous sinus fistula case 8. Symptoms include bulging eye, deteriorating vision and ringing in the ears. Classification and treatment of spontaneous carotid cavernous sinus fistulas. The carotidcavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. Carotidcavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. These arteriovenous av shunts can develop spontaneously, but the overwhelming majority 80% are the result of a traumatic injury to the ica or a branch artery. Venous drainage patterns in carotid cavernous fistulas. Four cases in which the diagnosis of carotidcavernous fistula was made by using ct angiography are illustrated. Trauma, aneurysm or vascular disease can create a carotid cavernous fistula.
Diagnosis and management of carotid cavernous fistulas. 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. Treatment of carotid cavernous fistulas springerlink. The fistula was successfully treated angiographically. The classic signs of a carotid cavernous fistula, including sudden onset of pulsating exophthalmos, a prominent bruit behind the affected eye, marked venous congestion and chemosis, impaired eye movement, and reduced visual acuity were present only in the patient with a traumatic direct internal carotid cavernous sinus fistula case 8. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. The diagnosis was confirmed by digital subtraction angiography in all four instances. Carotid cavernous fistulas ccf are acquired pathological direct shunts from the cavernous portion of the internal carotid artery ica into the enveloping cavernous sinus fig. 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.
Multiple venous drainage pathways are illustrated, including the left superior petrosal sinus thin black arrows, left inferior petrosal sinus thick black arrows, right. Carotidcavernous sinus fistula, cerebral angiography, therapeutic embolization, balloon occlusion. Caroticocavernous fistulas ccfs occur due to an abnormal communication between the highpressure carotid artery system and the relatively. As a result, the blood can drain properly from the eyes. A carotidcavernous sinus fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Links to pubmed are also available for selected references. Over the years, numerous classifications have been applied to ccfs. 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. The diagnosis of a ccf is readily made on catheter angiography by the demonstration of abnormal arteriovenous shunting into the cavernous sinus from either the ipsilateral cavernous ica or meningeal branches to the sinus wall in the case of an indirect fistula. A ccf can be due to a direct connection between the cavernous segment of. Meyer the term carotid cavernous fistula ccf refers to an abnormal communication between the internal carotid artery ica or one of its branches or the external carotid artery eca and the cavernous sinus cs. Carotid cavernous fistulas have been classified according to the hemodynamic.
Doctor answers on symptoms, diagnosis, treatment, and more. Carotid cavernous fistula can be effectively treated by occluding the fistula with transarterially deployable detachable balloons with preservation of the internal carotid artery. Blood can leak into the sinus cavity and destroy sensitive, surrounding tissue if a blood vessel bursts. Chapter 390 carotid cavernous fistulas giuseppe lanzino, fredric b. Carotidcavernous sinus fistulas and venous thrombosis. 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. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. This article is from june 2005 and may contain outdated material. Ruptured cavernous sinus aneurysms causing carotid. Barrow classification of carotidcavernous fistulas wikicns.
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. Treatment of carotid cavernous fistulas northwestern. Images in clinical medicine from the new england journal of medicine carotid cavernous fistula. Pdf carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. A 45yearold caucasian male presented to the emergency department of. We evaluated drainage patterns of ccfs by digital subtraction angiography dsa and categorized drainage pathways according to their types and etiology. If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can eventually lead to blindness. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Carotid cavernous fistula tytle and punukollu 105 coil disadvantages include the need to pack numerous coils to slow the fistula adequately to allow thrombosis to occur, unlike the direct and often immediate closure with balloon placement. Carotidcavernous fistula and carotid artery aneurysm sonoworld. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Hirai t, korogi y, baba y, nishimura r, hamatake s, kawanaka k, bussaka h, takahashi m. Spontaneous carotidcavernous fistulas are classified into the following groups. The fistula was supplied most prominently from the bilateral external carotid arteries and showed prominent retrograde drainage into the dilated left superior ophthalmic vein.
A carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull. Cavernous sinus or its dura the thin membrane that covers the cavernous sinus. 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. To our knowledge, this is the first report of the ct angiographic appearance of carotidcavernous fistulas. Spontaneous carotid cavernous fistula in a case with protein s deficiency that newly developed ophthalmoplegia after embolization. May 08, 2020 a carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull. In addition, brain arteriovenous malformation avm, 7. 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. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery.
Dural carotidcavernous fistulas neurosurgery clinics of north. Treating a carotid cavernous fistula with embolization involves placing small platinum coils where the abnormal connection is. 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. But treatment success rates for these fistulas now approach 100 percent when the repairs are performed early by experienced. The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. A ccf can be due to a direct connection between the. Carotid cavernous fistulas ccfs are abnormal connections between the blood vessels that take blood to and from the brain. Fractures or the shearing forces of severe head trauma. Caroticocavernous fistula radiology reference article.
A carotid cavernous fistula is an abnormal connection between the blood vessels in the brain. 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. Direct high flow shunt between ica and cavernous sinus. Presentation and treatment of carotid cavernous aneurysms. Panel b shows a postguglielmi detachable coil, ie, coiling of the fistula. 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. 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. A case of communicating carotid cavernous sinus fistula ccf after minor closed head injury is presented. These lesions may be classified based on the following.
Pdf carotidcavernous fistula in the emergency department. A healthy 18yearold man was in a motor vehicle accident and received. In most instances, endovascular treatment is preferred. Panel a is an angiogram of caroticocavernous fistula showing filling of the cavernous and circular sinuses. A case of communicating carotidcavernous sinus fistula ccf after minor closed head injury is presented. This frontal view shows the enlarged left carotidcavernous sinus fistula right compared to the normal right cavernous sinus left. The patient was urgently referred to neurointerventional radiology for diagnostic angiography and. This separates the blood flow of the carotid arteries from that of the veins. Apr 25, 2020 carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Carotidcavernous fistula definition of carotidcavernous. A ccf can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal. 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. Traumatic carotid cavernous fistula accompanying basilar skull fracture. This article is from march 2008 and may contain outdated material.
Oct 28, 2015 a caroticocavernous fistula results in highpressure arterial blood entering the lowpressure venous cavernous sinus. A carotidcavernous fistula ccf is an abnormal communication between arteries and veins within the cavernous sinus and may be classified. The characteristic clinical features seen in patients with ccfs are. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Direct puncture of the cavernous sinus for obliteration of a recurrent carotidcavernous fistula. The red arrow points to coils within the cavernous and circular sinuses after obliteration of. To our knowledge, this is the first report of the ct angiographic appearance of carotid cavernous fistulas. Carotid cavernous fistula ccf is the abnormal communication between the internal carotid artery and the cavernous sinus. Carotid cavernous fistula definition of carotid cavernous. Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. In direct fistulas there is an abnormal communication between the internal carotid artery and the cavernous sinus. A 45yearold caucasian male presented to the emergency department of a tertiary care.
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