Fístula carótido-cavernosa com epistaxe letal: relato de caso

Borba, Rover; Sonda, Ildo; Dini, Leandro Infantini; Calcagnotto, Fernando Nora; Marchett, Nicole; Cobalchini, Paula Cristina

doi:10.1590/s0004-282x2001000200027

Cited by 10 publications

(17 citation statements)

References 9 publications

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“…Aproximadamente 75% de todas as FCC relatadas são causadas por traumatismos grave, como acidentes automobilísticos ou traumas penetrantes. Estas lesões de alta transmissão de energia resultam em alterações do curso da ACI com comunicação direta para o SC podendo resultar em paralisia de nervos cranianos, amaurose, hemorragia subaracnoidea (HSA) e, mais raramente, epistaxe, podendo ser maciça e causar iminente risco de vida ao paciente 28,30 .…”

Section: Discussionunclassified

Fístula Carótido-cavernosa Espontânea: descrição de caso e revisão de literatura

Filho¹,

Beilfuss²,

Machado³

et al. 2019

jbnc

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Introdução: Fístulas carótido-cavernosa (FCC) são comunicações espontâneas ou adquiridas entre a artéria carótida interna (ACI) e o seio cavernoso (SC) que provocam um shunt com desvio do fluxo sanguíneo arterial para o SC. Ocorre uma reversão do fluxo sanguíneo das veias tributárias do SC, assim como o seu aumento nas vias para sua drenagem, causando uma variedade de sintomas devido às inúmeras veias que se comunicam com o mesmo. Relato de Caso: Paciente feminina, 44 anos com queixa de cefaleia súbita e intensa, em região temporal esquerda, durante atividade física. Evolução com piora da cefaleia, exoftalmia ipsilateral, quemose conjuntival e edema periorbitário. Ao exame neurológico, apresentou sopro carotídeo em região fronto-temporal esquerda. AngioRM sugeriu a presença de FCC, posteriormente confirmada pela arteriografia cerebral com subtração digital. Foi submetida a embolização com micromolas, sem intercorrências. Conclusão: Dentre os casos de FCC, os de etiologia espontânea são minoria. O sistema de alta pressão criado no seio foi responsável por sua sintomatologia, uma vez que impedia o retorno venoso da veia oftálmica. Nossa paciente foi submetida a tratamento endovascular, apresentando remissão completa dos sintomas

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Section: Discussionunclassified

Fístula Carótido-cavernosa Espontânea: descrição de caso e revisão de literatura

Filho¹,

Beilfuss²,

Machado³

et al. 2019

jbnc

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“…Surgical approaches are designed to either provide direct access to or bypass the lesion. A direct approach to the cavernous and petrous ICA is challenging because anatomic con- Endovascular treatment of the pseudoaneurysm may be with coils, stent, covered stent, or ICA balloon occlusion 6,7,9,15,16 . Embolization with detachable platinum coil, sometimes associated with stent, provides intracranial pseudoaneurysm obliteration while maintaining ICA flow 14 .…”

Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm of the internal carotid artery presenting with massive (recurrent) epistaxes: a life-threatening complication of craniofacial trauma

Zanini

Tahara

Santos

et al. 2008

Arq. Neuro-Psiquiatr.

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Vascular lesions can be serious complications resulting of blunt or penetrating trauma 1,2 . Internal carotid artery lesion is one of most serious and relatively frequent in all mechanisms of craniofacial trauma. Several clinical manifestations can occur as central neurologic and cranial nerves deficits as well as several degrees of bleeding (from mild symptomatic to fatal). Recurrent and massive epistaxis can occur after trauma due to pseudaoneurysms of the external and internal carotid artery (ICA) 3,4 . Considering its life-threatening course, the assisting physician has a relatively narrow time to detect and treat these lesions.We present two cases of recurrent and massive epistaxis secondary to ICA pseudoaneurysm following blunt and perforating trauma. Evolution was fatal in the first case with delayed treatment and uneventfully in the second which was treated by occlusion of the pseudoaneurysm and ICA via endovascular intervention. CASES Case 1A 22-year-old girl suffered a motor vehicle accident with facial and cranial blunt trauma six months earlier. On admission at another institution, she presented nasal and oral bleeding and normal neurological examination (Glasgow score 15). Admission computed tomography (CT) showed basal orbitofrontal and maxillary fracture and no abnormality in the paranasal sinus (Fig 1). In subsequent days, she developed progressive right eye amaurosis, facial hypoesthesia, and epistaxis. Orbital decompressive surgery was performed. Over the next months she had some recurrent nasal bleeding episodes which were controlled by nasal packing. CT performed 5 months later showed an eroding mass in the sphenoidal sinus with enhanced contrast media inside (Fig 2). Magnetic resonance imaging (MRI) showed a flow void inside the mass, and a pseudoaneurysm was suspected

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“…Traumatic pseudoaneurysms presenting with recurrent epistaxis are even rarer, from 1928 when Birley and Trotter first reported such a case to 1990, only about 100 cases have been reported in the world literature 3,14 . Traumatic CCF concomitant with pseudoaneurysm in the sphenoid sinus presenting with epistaxis is an extremely rare occurrence with few reports in the literature 4,15,21,18,19 . It is well known that the ICA is divided into four portions: cervical, petrous, cavernous and cerebral.…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic carotid cavernous fistula concomitant with pseudoaneurysm in the sphenoid sinus reported in the literature mostly resulted from penetrating head trauma and motor vehicle accidents 4,18,19,26 . Intracavernous carotid artery pseudoaneurysm occurring after transsphenoidal microsurgery has been well reported 11,12 , but we never found reported concomitant with CCF.…”

Section: Discussionmentioning

confidence: 99%

“…5,7,8,26 . But for traumatic carotid cavernous fistula with concomitant pseudoaneurysm in the sphenoid sinus, the treatment methods are confined to endovascular coils, detachable balloons and trapping procedures 4,15,18,19 . At present, most neuroradiologists believe that a traumatic pseudoaneurysm is only a fragile sac surrounded by organizing blood clot that may even disappear with fibrinolysis, there may be little tissue to hold or buttress the balloon in place over the laceration in the carotid artery.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic Carotid Cavernous Fistula Concomitant with Pseudoaneurysm in the Sphenoid Sinus

Huai

et al. 2008

Interv Neuroradiol

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This study was designed to elucidate the generating mechanism, diagnosis and treatment of traumatic carotid cavernous fistula (tCCF) concomitant with pseudoaneurysm in the sphenoid sinus. Six cases of tCCF concomitant with pseudoaneurysm in the sphenoid sinus were analyzed in this study. Clinical history, neurological examination, CT and MRI scans, pre- and postembolization cerebral angiograms and follow-up data were included. All patients presented with massive epistaxis and symptoms of tCCF. The pseudoaneurysms and fistulas were occluded with detachable balloons, and preservation of the parent artery in two cases. One patient also had indirect carotid cavernous fistula (CCF) on the contralateral side embolized by transfacial vein approach with microcoils. Complete symptom resolution was achieved in all cases, without procedure related complications. During the follow-up period all patients returned to work. Falling from a high speed motorcycle without wearing a helmet may be one of the main causes of this disease. The site of impact during the accident mostly localizes in the frontal and lateral of the orbit. Intracavernous sinus hypertension of tCCF combining with fracture of the lateral wall of the sphenoid may lead to the formation of a pseudoaneurysm in the sphenoid sinus. MRI scan is very helpful in the diagnosis of this disease before the patient receives angiography. Detachable balloon occlusion of the pseudoaneurysm and fistula is a safe and efficient treatment.

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Fístula carótido-cavernosa com epistaxe letal: relato de caso

Cited by 10 publications

References 9 publications

Fístula Carótido-cavernosa Espontânea: descrição de caso e revisão de literatura

Fístula Carótido-cavernosa Espontânea: descrição de caso e revisão de literatura

Pseudoaneurysm of the internal carotid artery presenting with massive (recurrent) epistaxes: a life-threatening complication of craniofacial trauma

Traumatic Carotid Cavernous Fistula Concomitant with Pseudoaneurysm in the Sphenoid Sinus

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