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