Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

Supasai, Pawasoot; Kanjana, Kanwasee; Yospaiboon, Yosanan

doi:10.2147/opth.s410930

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…This study was an extended study of our previous report on comparison of clinical characteristics between direct and dural CCFs. 12 It followed the tenets of the Declaration of Helsinki and was approved by the Khon Kaen University Ethics Committee for Human Research. Medical records of all patients diagnosed as CCFs at the KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, from January 2015 to December 2020 were retrospectively reviewed.…”

Section: Methodsmentioning

confidence: 99%

Clinical Risk Score for Prediction of Urgency in Carotid Cavernous Sinus Fistulas

Supasai¹,

Kanjana²,

Yospaiboon³

2023

OPTH

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To develop a clinical risk score for the prediction of urgency in patients with carotid cavernous sinus fistulas (CCFs) and test for the discriminative ability of the diagnostic prediction. Methods: The medical charts of 60 patients with CCFs were retrospectively reviewed. The clinical characteristics of direct and dural CCFs were analyzed by logistic regression. The clinical risk score was developed from the coefficient in the multivariable regression model and used to predict direct CCFs which were more urgent than the dural type. The score prediction was reported as an area under the receiver operating characteristic (AuROC) curve and 95% confidence interval (95% CI). Results: In a univariable analysis, the clinical characteristics which increased the risk of direct CCFs were age, gender, trauma, underlying diseases, visual acuity (VA) at presentation, bruit, chemosis, and dilated retinal vessels. However, in multivariable analysis, the significant predictors were limited to age, trauma, bruit, underlying diseases and logMAR VA. Regression coefficient of each predictor was converted to a risk score and summation of scores from these predictors for each patient was calculated. The total risk score predicted the urgent direct CCFs correctly with AuROC of 97.77% (95% CI; 93.57, 100). Conclusion:The clinical risk score for the prediction of urgent direct CCFs has been developed and used in the patients with CCFs in our setting. The discriminative ability of the score prediction is high. This simple clinical risk score may help clinicians suspect direct CCFs and urgently refer the patients to have prompt angiography and treatment.

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Section: Methodsmentioning

confidence: 99%

Clinical Risk Score for Prediction of Urgency in Carotid Cavernous Sinus Fistulas

Supasai¹,

Kanjana²,

Yospaiboon³

2023

OPTH

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“…The purpose of our retrospective study 4 is to compare the clinical characteristics of patients with direct and dural CCFs. The results show that patients with direct CCFs were younger, associated with trauma, and had more visual impairment at presentation.…”

Section: Dear Editormentioning

confidence: 99%

Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Response to Letter]

Supasai¹,

Kanjana²,

Yospaiboon³

2023

OPTH

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Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Letter]

Graziano¹,

Biondino²,

Fioretto³

2023

OPTH

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We read the article by Supasai et al on the clinical differences between Direct and Dural Carotid Cavernous Sinus Fistulas (CCFs) with great interest and would like to provide additional insights. 1 CCFs are vascular abnormalities that can be classified based on pathogenesis, hemodynamics, and angiography. Pathogenic classification divides CCFs into two subgroups: traumatic and spontaneous. Hemodynamic classification divides CCFs based on flow into low or high subgroups. Lastly, angiographic classification subdivides CCFs into direct and dural fistulas. Direct fistulas show a direct communication between the internal carotid artery and cavernous sinus, while dural fistulas are further divided into three sub-groups based on the location of shunting. Direct fistulas are usually caused by trauma and exhibit a high flow rate, instead dural fistulas are usually spontaneous and exhibit a low flow rate.The authors endeavored to differentiate between the clinical features and symptoms of direct and dural CCFs. While individuals who exhibit ocular symptoms, such as proptosis, red eye, and glaucoma, might initially consult an expert ophthalmologist, we believe that relying solely on clinical features might be inadequate for distinguishing between them.We were surprised to see that no mention was present in the paper concerning the use of the echographic findings.Echography is widely used as a non invasive method to differentiate several disease, among others papilledema due to intracranial hypertension 2 from optic nerve drusen. 3 However it has also been suggested to rapidly detect and differentiate between dural and direct CCFs since late 1970s with the so called standardized echography by KC Ossoinig 4 utilizing B scan together with an A scan with an 8 MHz non-focused probe with S-shaped amplification that provides more accurate information and measurements of structures than the B-scan technique alone. 5 In case of direct CCFs, ultrasound detects dilation of the superior ophthalmic vein with pulsation of the walls, vertical veins, and sometimes the inferior ophthalmic vein due to arterialization and increased flow within these vessels. A low and regular reflectivity, weak sound attenuation with an angle k lower than 30°, and the presence of rapid spontaneous movements in the lumen of these vessels indicating flow arterialization.In cases of dural CCFs, A-scan ultrasound shows thickening of all orbital structures, particularly the extraocular muscles and optic nerve sheaths due to venous congestion in the orbit. The extraocular muscles will appear thickened only on the affected side, with normal reflectivity in the initial phase and subsequently high and irregular reflectivity.Therefore, we recommend using standardized echography for a rapid and accurate differentiation between dural and direct CCFs after the clinical exam.

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Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

Cited by 4 publications

References 25 publications

Clinical Risk Score for Prediction of Urgency in Carotid Cavernous Sinus Fistulas

Clinical Risk Score for Prediction of Urgency in Carotid Cavernous Sinus Fistulas

Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Response to Letter]

Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Letter]

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