Carotid-cavernous fistulas (CCFs) result from an anomalous connection between the internal and/or external carotid arteries and the cavernous sinus.The cavernous sinus comprises a network of venous channels through which the cavernous portion of the internal carotid artery (ICA), the internal carotid sympathetic plexus, and cranial nerve (CN) VI course. The CNs III, IV, and V (first and second divisions) run within the dura of the lateral wall of the cavernous sinus [1]. Carotid-cavernous fistulas can be classified by: • etiology: traumatic or spontaneous; • flow volume and speed: high or low; • angiographic architecture: direct or indirect. The most commonly used classification scheme for the latter was established by Barrow et al. He divided CCFs into four types, depending on the arterial feeders. Type A fistulas represent direct communications between the ICA and the cavernous sinus, usually associated with high flow rates. Indirect fistulas (types B, C, and D) are dural CCFs fed by the this article is available in open access under Creative Common attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
Background: The aim of this study was to evaluate the characteristics of the macular vessel density (VD) and the foveal avascular zone (FAZ) in glaucoma quantitatively using the optical coherence tomography angiography (OCT-A). Methods: Twenty-five eyes of 13 patients with primary open angle glaucoma (POAG) and 12 eyes of 6 healthy participants were enrolled retrospectively. Functional visual field (VF) and structural Spectral-Domain optical coherence tomography (SD-OCT) Retinal Nerve Fiber Layer Thickness (RNFLT) were assessed in all participants. OCT-A was performed on a fovea centered, 15x10 degrees, macular region. OCT-A scans were processed with MATLAB software and automatically graded to define FAZ parameters. The parafoveal VD in the superficial and deep retinal vascular plexus (SVP and DVP) was analyzed by quadrant and circular segmented zones. Results: Foveal Avascular Zone -Major Axis Length (p=0.02), Area (p=0.04), Equivalent Diameter (p=0.04) and Perimeter (p=0.04) were significantly larger in glaucoma than the control group. Regarding SVP and DVP, the average macular total VD were lower in glaucoma patients compared to the control group (p<0.01; p<0.01). Additionally, the inner circular region (p=0.04; p<0.01 respectively for SVP and DVP) and all quadrants except for North had a lower VD in glaucoma group compared to the control group. Assessment of the total VD successfully predicted RNFLT (p<0.001) and was significantly associated with the probability of glaucoma (p=0.009). Conclusion: OCT-A parameters, namely the FAZ morphology and the macular VD, were associated with glaucomatous functional and structural changes. The macular VD showed a considerable diagnostic value. It may be a modern biomarker, representing microvascular network disruption of the macular perfusion in glaucoma.
PurposeTo describe the clinical presentation of carotid cavernous fistulas (CCFs) managed in Egas Moniz Hospital between January 2010 and September 2020.MethodsPatients presenting with orbital congestive signs and symptoms with a diagnosis of CCF confirmed by digital subtraction angiography and ophthalmological evaluation were included retrospectively. Clinical presentation and angiographic findings were collected, and a descriptive study was performed.ResultsTen patients were identified, 7 of which female, with an average age of 62.7 years old. All of our patients presented with ophthalmological complaints. The most frequently seen signs/symptoms were red eye (n = 8), increased intra‐ocular pressure (IOP) (n = 8) and ophthalmoparesis with diplopia (n = 7). Regarding the latter, 5 patients had paresis of the abducens nerve, 1 had a third nerve palsy and another had both. Proptosis and chemosis were observed in 5 and 4 patients, respectively. Tinnitus, fundus abnormalities and decreased visual acuity were reported by 3 patients. One patient presented with headache. In respect to the angiographic classification, 2 were direct and 6 indirect. One case was not classified and the other case refers to an intra‐clival Cognard type IV arteriovenous fistula that drains to the cavernous sinus and therefore closely resembling a CCF. Two patients were managed conservatively, while the remainder were submitted to endovascular procedures. After treatment, the most frequent persistent signs/symptoms were increased IOP (n = 7) and ophthalmoparesis with diplopia (n = 5).ConclusionsCCFs are rare and difficult to diagnose. Direct CCFs tend to have a more severe, acute onset presentation while indirect CCFs are associated with a more gradual onset and chronic course. In both, anterior and inferior drainages are the most common. Clinical presentation can be varied and nonspecific, however, patients commonly present with ophthalmological manifestations.
Pituitary adenomas account for approximately 15% of all brain tumors. They are the most common cause of sellar tumors after the third decade of life, representing 90% of all sellar masses, with a majority of prolactinomas [1, 2]. Most of these tumors are intrasellar. However, they may extend to the suprasellar and parasellar regions and invade adjacent structures such as the cavernous sinuses and the bone of the sella turcica and clivus [3].Clinically, they may be asymptomatic or with classic syndromes of hyper-or hypopituitarism and symptoms due to local mass effects, such as headaches, vomiting, dizziness, diplopia, or visual this article is available in open access under Creative Common attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
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