Endovascular treatment of the carotid-cavernous vascular lesions

Abstract

Introduction: The treatment of lesions which compromise the cavernous sinus has always constituted a challenge. The endovascular treatment of these lesions has presented diverse alterations over the last years. This study aims to evaluate the endovascular treatment of vascular lesions in the internal carotid artery (ICA), cavernous segment, performed at our service. Method: This is a descriptive study, retrospective and prospective. Patients with aneurysm in the cavernous ICA or direct carotid-cavernous fistula (dCCF) submitted to endovascular treatment were evaluated. Results: Included were 26 patients with intracavernous aneurysms and 10 with dCCF. All aneurysms were treated with ICA occlusion. The dCCF were treated with occlusion of the ICA in seven cases and with selective fistula occlusion in the remaining three. There was an improvement in pain and ocular proptosis in all patients with dCCF. In the patients with intracavernous aneurysms, the incidence of retroorbitary pain went from 84.6% to a mere 30.8%, following the treatment. Following endovascular treatment, there was an important improvement in the dysfunction of cranial nerves, compromised in both patient groups, mainly in the oculomotor nerve. Conclusion: The endovascular treatment provided an improvement in the patients of this study, especially in the criteria pain and oculomotor nerve dysfunction.

Trauma of the midface

“…Fractures that extend through the canal of the carotid artery may lead to pseudoaneurysm, dissection of the vascular wall, thrombosis with consecutive blindness or stroke, and carotid cavernous sinus fistulas [ 31 ], [ 32 ]. Malposition of the eye and pulsating exophthalmos are clinical signs of carotid cavernous sinus fistulas [ 33 ], [ 34 ], [ 35 ]. In rare cases, pressure-induced paresis of the abducens nerve may occur [ 36 ].…”

Traumatologie des Mittelgesichts

“…Die Carotis-Sinus cavernosus-Fisteln werden klinisch durch Fehlstellung des ipsilateralen Auges und durch einen ggf. auch pulsierenden Exophthalmus auffällig [34][35][36]. In seltenen Fällen kann es auch zu druckbedingten Lähmungen des N. abducens kommen [37].…”