Carotid-cavernous fistulas

Abstract

<jats:p>Carotid-cavernous fistulas (CCFs) are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. The characteristic clinical features seen in patients with CCFs are the sequelae of hemodynamic dysfunction within the cavernous sinus. Once routinely treated with open surgical procedures, including carotid ligation or trapping and cavernous sinus exploration, endovascular therapy is now the treatment modality of choice in many cases. The authors provide a review of CCFs, detailing the current classification and clinical management of these lesions. Therapeutic options including conservative management, open surgery, endovascular intervention, and radiosurgical therapy are presented. The complications and treatment results as reported in the contemporary literature are also reviewed.</jats:p>

Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

“…3,8,9 According to Ellis et al, these disorders are caused by ischemia of the retina and require urgent treatment. 1 Wang et al share that ophthalmoplegia is observed in 23-63% of cases, while disturbances in other cranial nerves are less common (17-44%), which is confirmed by the clinical presentation observed in our case. 9 CT and magnetic resonance angiography can visualize the dilated cavernous sinus and diagnose the CCF.…”

“…1,3,7 The age of our patient and the lack of history of previous facial craniocerebral trauma are suggestive of the spontaneous nature of the CCF. The absence of clinical evidence of fi bromuscular dysplasia, EhlersDanlos syndrome and elastic pseudoxanthoma suggested the presence of an intracavernous aneurysm, but it was not visualized by neuroimaging.…”

“…1,4 It is believed that the weakness of the arterial walls in these patients predisposes them to the development of CCF even as a result of minimal increase of pressure, such as sneezing or the Valsalva maneuver. 1 In the absence of aneurysms or other risk factors, it is assumed that a microscopic vein thrombosis may cause a lesion of a dural vessel in the CS leading to the development of CCF, especially in cases with arterial hypertension, atherosclerosis, pregnancy, minor injuries, diabetes and collagen diseases. 1,2,5,6 We present a case of successful endovascular embolization of spontaneous direct CCF.…”

“…1 In the absence of aneurysms or other risk factors, it is assumed that a microscopic vein thrombosis may cause a lesion of a dural vessel in the CS leading to the development of CCF, especially in cases with arterial hypertension, atherosclerosis, pregnancy, minor injuries, diabetes and collagen diseases. 1,2,5,6 We present a case of successful endovascular embolization of spontaneous direct CCF. (Fig.…”

“…CCF are classifi ed according to their etiology as traumatic or spontaneous; according to the blood fl ow velocity -as high or low-velocity, and in terms of their angiographic architecture -direct (by the ICA itself) or indirect -by a branch of the ICA or the external carotid artery (ECA). 1 Barrow et al defi ne four types (A -D) of CCF, depending on the blood supply. 2 Type A is the most common (75-80%) and is a direct, high-velocity shunt from the ICA to the CS, caused by a lesion of the wall of the artery due to trauma or aneurysmal rupture.…”