Thrombosis of venous outflows of the cavernous sinus: possible aetiology of the cortical venous reflux in case of indirect carotid-cavernous fistulas

Robert, Thomas; Sylvestre, Philippe; Blanc, Raphaël; Botta, D.; Cicciò, Gabriele; Smajda, Stanislas; Redjem, Hocine; Piotin, Michel

doi:10.1007/s00701-017-3079-2

Cited by 14 publications

(6 citation statements)

References 30 publications

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“…Während direkte Fisteln häufig posttraumatisch, iatrogen oder nach Ruptur eines Aneurysmas entstehen [ 3 , 4 ], ist die genaue Ätiologie der indirekten Fisteln ungeklärt. Diskutiert wird ein spontanes Auftreten im Bereich von postthrombotischen oder postinfektiösen Umgehungskreisläufen im venösen Abflussweg [ 5 ]. Die klinische Symptomatik hängt im Wesentlichen vom arteriovenösen Shuntvolumen und dem venösen Drainagemuster ab.…”

Section: Hintergrund Und Fragestellungunclassified

Klinische und echographische Untersuchungsbefunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln

et al. 2021

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Zusammenfassung Hintergrund Die Symptomatik und klinischen Befunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln sind spezifisch, können aber sehr mild ausgeprägt sein. Wir wollen das diagnostische Potenzial der Echographie der Orbita näher beleuchten. Methoden In die retrospektive Studie wurden 25 Patienten mit angiographisch gesicherten Fisteln eingeschlossen. Symptome, klinische Untersuchungsergebnisse und die Darstellbarkeit der V. ophthalmica superior in der orbitalen Echographie wurden gegenübergestellt. Ergebnisse Die häufigsten Befunde waren Hirnnervenparesen, episklerale Venenstauung oder Exophthalmus. Wurde eine orbitale Ultraschalluntersuchung durchgeführt, konnte eine erweiterte V. ophthalmica superior zu 100 % nachgewiesen werden. Schlussfolgerung Die schnell durchführbare Ultraschalluntersuchung liefert wertvolle Informationen zur Differenzialdiagnose eines therapieresistenten roten Auges. In Kombination mit den 3 Kardinalsymptomen episklerale Venenstauung, Exophthalmus und Hirnnervenparese lässt sich die Diagnose einer Carotis-Sinus-cavernosus-Fistel durch die Echographie untermauern. Die weiterführende Bildgebung kann schließlich zielgerichtet veranlasst werden.

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Section: Hintergrund Und Fragestellungunclassified

Klinische und echographische Untersuchungsbefunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln

et al. 2021

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“…19 The pathogenesis of dural CCFs likely involves a primary thrombosis of cavernous sinus venous outflow channels and resultant vascular alterations to provide collateral flow. 22,24,25 This theory of pathogenesis is widely supported because it also accounts for the development of arteriovenous fistulas involving other dural sinuses. 18 However, some authors favour a conflicting theory, which purports that dural CCFs form after rupture of one or more thin-walled dural arteries, leading to the dilation of pre-existing dural-arterial anastomoses.…”

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confidence: 99%

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Henderson

Miller

2017

Eye

183

232

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A carotid-cavernous fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as either direct or dural. Direct CCFs are characterized by a direct connection between the internal carotid artery (ICA) and the cavernous sinus, whereas dural CCFs result from an indirect connection involving cavernous arterial branches and the cavernous sinus. Direct CCFs frequently are traumatic in origin and also may be caused by rupture of an ICA aneurysm within the cavernous sinus, Ehlers-Danlos syndrome type IV, or iatrogenic intervention. Causes of dural CCFs include hypertension, fibromuscular dysplasia, Ehlers-Danlos type IV, and dissection of the ICA. Evaluation of a suspected CCF often involves non-invasive imaging techniques, including standard tonometry, pneumotonometry, ultrasound, computed tomographic scanning and angiography, and/or magnetic resonance imaging and angiography, but the gold standard for classification and diagnosis remains digital subtraction angiography. When a direct CCF is confirmed, first-line treatment is endovascular intervention, which may be accomplished using detachable balloons, coils, liquid embolic agents, or a combination of these tools. As dural CCFs often resolve spontaneously, low-risk cases may be managed conservatively. When invasive treatment is warranted, endovascular intervention or stereotactic radiosurgery may be performed. Modern endovascular techniques offer the ability to successfully treat CCFs with a low morbidity and virtually no mortality.

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“… 44 One cavernous fistula in our series exhibited a partial venous outflow thrombosis as in some adult cavernous fistulas. 45 Sinus thrombosis was also observed in the majority (83.6%) of ADAVS occurring secondarily in VGAM-treated patients, distant from the VGAM shunt itself as located on either transverse or superior sagittal sinuses and clearly different from the dural shunts that have been described at this level. 46 Unlike IDAVS that results from diffuse unregulated angiogenic activity, ADAVSs are considered as a focal post-thrombotic sprouting angiogenic response.…”

Section: Discussionmentioning

confidence: 88%

Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management

Smajda

Söderman

Dorfmüller

et al. 2022

Brain Communications

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Paediatric intracranial dural arterio-venous shunts have clinical presentations and evolutions, with angiographic characteristics that differ from those described in adults. We report our experience concerning their therapeutic management, emphasizing the relevance of early diagnosis and appropriate treatment for satisfactory neurocognitive development. Using a prospective database, we reviewed the clinical and radiological data of all children with dural arteriovenous shunts managed between 2002 and 2020. Dural shunts were categorized into three types: dural sinus malformations with arteriovenous shunts; infantile dural arteriovenous shunts; adult-type dural arteriovenous shunts. Therapeutic strategies and outcomes were analyzed depending on lesional subtypes. Modified Rankin Scale for the paediatric population was assessed pre-treatment and at last follow-up. Twenty-eight patients (16 girls [57.1%]; 12 boys [42.9%]) were included: 17 dural sinus malformation (10 boys [58.8%]; seven girls [41.2%]), three infantile shunts (three girls [100%]), eight adult-type shunts (four girls [50%]; four boys [50%]), with a mean age of 19.2±36.6 months at presentation. Twelve (42.9%) had a modified Rankin Scale score of 0-2, four (14.3%) a score of 3, three (10.7%) a score of 4 and eight (28.6%) a score of 5. Embolization was performed in 22 children (78.6%; 12 girls [54.5%]; 10 boys [45.5%]). Fifteen patients could be cured (68.2%): 11 dural sinus malformations (73.3%), four adult-type lesions (100%), but no infantile shunt. Mean post-treatment follow-up was 39.5 months (max. 139 months): 14 patients (63.6%) presented a modified Rankin Scale score 0-2 and eight (36.4%) a score ≥3. In the dural sinus malformation group, the modified Rankin Scale score was improved in 11 patients (73.3%) and unchanged in three (20%). Only one patient with infantile subtype (33.3%) improved clinically. In the adult-subtype group, all children (100%) improved. Of six untreated patients (four girls [66.7%]; two boys [33.3%]), four with adult-subtype shunts showed uneventful evolutions, one with dural sinus malformation died, and therapeutic abortion was conducted in an antenatally diagnosed dural sinus malformation. Pediatric dural fistulas comprise different subtypes with variable clinical courses. Proper diagnosis is mandatory for optimal therapeutic strategies within appropriate therapeutic windows.

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Thrombosis of venous outflows of the cavernous sinus: possible aetiology of the cortical venous reflux in case of indirect carotid-cavernous fistulas

Cited by 14 publications

References 30 publications

Klinische und echographische Untersuchungsbefunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln

Klinische und echographische Untersuchungsbefunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management

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