Spontaneous Resolution of Two Dural Carotid-Cavernous Fistulas Presenting With Optic Neuropathy and Marked Congestive Ophthalmopathy

Abstract

Two patients with dural carotid-cavernous fistulas (CCFs) presented with optic neuropathy and marked congestive ophthalmopathy, including 1 patient with a narrowed anterior chamber angle due to choroidal effusions. Endovascular intervention was planned but deferred for logistic reasons. While the patients awaited the procedures, the clinical features markedly improved, and time-resolved imaging of contrast kinetics (TRICKS) MRA was consistent with closure of the CCFs. These patients serve as a reminder that spontaneous resolution may occur in dural CCFs even when presenting clinical features are florid and vision appears to be threatened. In fact, a rapid worsening of clinical manifestations may be a sign that a dural CCF is about to close spontaneously.

Spontaneous angiographic changes in venous drainage patterns related to symptom changes in patients with untreated cavernous sinus dural arteriovenous fistula

“…Bujak et al reported 2 cases with optic neuropathy and marked congestive ophthalmopathy as manifestations of CSdAVF. Although these patients did not undergo interventional management, they eventually showed dramatic improvement in symptoms and complete regression of the fistula [11]. This paradoxical worsening of presenting symptoms before spontaneous occlusion may have been the result of increased venous pressure caused by thrombus formation of the affected vein [23,25].…”

“…Among the 34 untreated CSdAVF patients, 21 patients (male/female, 7/14; mean age, 59.7 years; median clinical follow-up, 12 months; range, 3-151 months) manifested symptom changes, and 16 underwent follow-up angiography after symptom changes. The median interval of symptom changes was 4 months (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14], and the median time interval from initial angiography to follow-up angiography was 4 months (range, 1-69). On initial digital subtraction angiography (DSA), patients comprised 8 with type I, 1 with type II, and 8 with type III, including 2 with type IIIC, and 2 with type IV.…”

“…Some case reports have shown spontaneous occlusion of some CSdAVFs [11][12][13][14][15]. However, many of these patients had undergone palliative treatment, and little is known about whether or how often untreated CSdAVFs show angiographic changes over time [7,9,10].…”

Paradoxical Worsening of Ocular Symptoms after Spontaneous Closure of a Carotid Cavernous Fistula: Case Report

“…19 patients had a preoperative GCS score ranging from [3][4][5]49 patients ranged from 6-9 and 33 patients were greater than 9. The mean preoperative score was 8.…”

“…[1][2][3][4][5][6]10 When standard treatments for elevated ICP are exhausted without any signs of improvement, decompressive craniectomy can be an effective alternative solution.…”