Delayed contralateral traumatic carotid cavernous fistula after craniomaxillofacial fractures

Abstract

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

“…Liquid glue's reflux to internal carotid via fistula is the most severe complication of TCCF treatment. It might be related to fast speed of injecting glue [ 15 ]. If blood flow velocity of the fistula is fast, injecting fast can easily cause Onyx glue to reflux to internal carotid, which will lead to an ischemia stroke [ 16 ].…”

Contralateral traumatic carotid cavernous fistula after a craniomaxillofacial fracture

“…Carotid-cavernous fistula is an abnormal shunt between the CS and the intracavernous segment of the ICA or one or more branches of either or both the ICA or external carotid artery [ 1 , 5 ].…”

“…The CS is a reticulated structure formed by an assembly of multiple thin-walled veins in which the ICA and multiple nerves pass though the vein network. When a direct CCF is formed, arterial blood enters the cavernous sinus at high pressure; it can cause blood flow reversal and interferes with normal venous return to the cavernous sinus [ 1 ], dilatation of the upstream venous network with arterialization is observed [ 9 , 10 ]. Such venous flow can affect the ophthalmic vein, leading to orbital congestion, and manifestations such as proptosis, ophthalmic fremitus or bruit and chemosis [ 1 ].…”

“…When a direct CCF is formed, arterial blood enters the cavernous sinus at high pressure; it can cause blood flow reversal and interferes with normal venous return to the cavernous sinus [ 1 ], dilatation of the upstream venous network with arterialization is observed [ 9 , 10 ]. Such venous flow can affect the ophthalmic vein, leading to orbital congestion, and manifestations such as proptosis, ophthalmic fremitus or bruit and chemosis [ 1 ]. The perfusion pressure of the ophthalmic artery is simultaneously reduced, which causes retinal ischaemia and visual disturbances [ [1] , [2] , [3] ].…”

“…Carotid-cavernous fistula (CCF) is an abnormal shunt between the carotid artery, or one of its branches, and the cavernous sinus (CS), allowing the blood to flow from the carotid system to the CS. CCF can be either direct or indirect communication, depending on the etiology [ 1 , 2 ]. Skull base fracture after a craniomaxillofacial trauma is responsible for 70%–90% of direct CCF [ 3 ].…”