Treatment of low flow, indirect cavernous sinus dural arteriovenous fistulas with external manual carotid compression – the UK experience

Kalsi, Pratipal; Padmanabhan, R; S, Manjunath Prasad K; Mukerji, Nitin

doi:10.1080/02688697.2020.1716947

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…Patients with lesions presenting with no or mild symptoms and no CVR can be conservatively managed with regular follow-ups. Sometimes, a maneuver such as external manual carotid compression is reported to be effective for some DAVFs [ 25 , 35 ]. However, most symptomatic lesions should be considered for treatment with available modalities, including endovascular intervention, surgery, radiosurgery/radiotherapy, or a combination of these therapeutic options.…”

Section: Treatmentmentioning

confidence: 99%

Role of surgery in management of intracranial dural arteriovenous fistulas

Kang

Cho

Lee

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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Intracranial dural arteriovenous fistulas (DAVF) are abnormal connections between intracranial arterial and venous systems within the dural layers. Intracranial DAVFs are rare but can occur wherever dural components exist. The pathogenesis of DAVFs is controversial. Venous hypertension is considered as a main cause of clinical symptoms which are subclassified into asymptomatic, benign and aggressive manifestations. To date, several classification schemes have been proposed to stratify the natural course and risks of DAVFs. Currently, endovascular therapy is the main treatment modality. Moreover, the use of radiosurgery and radiotherapy has been limited. Open surgery is also selectively performed as a main treatment modality for specific types of DAVFs and an adjunctive modality for the endovascular approach. Herein, we present a review of the general perspectives of intracranial DAVFs with an emphasis on the role of surgery.

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Section: Treatmentmentioning

confidence: 99%

Role of surgery in management of intracranial dural arteriovenous fistulas

Kang

Cho

Lee

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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“…Low-flow CSDAVF is also known as “Red Eye Short-circuit Syndrome,” and mostly occurs in middle-aged and elderly women without a history of trauma. It mainly manifests as dilated and tortuous superior scleral and conjunctival veins, elevated superior scleral venous pressure and intraocular pressure [8] . In this case report, the patient's conjunctival and fundus veins were dilated and tortuous, without pulsatile murmurs and tinnitus, and she was diagnosed with low-flow CSDAVF.…”

Section: Discussionmentioning

confidence: 73%

“…It mainly manifests as and tortuous superior scleral and conjunctival veins, elevated superior scleral venous pressure and intraocular pressure. [8] In this case report, the patient's conjunctival and fundus veins were dilated and tortuous, without pulsatile murmurs and tinnitus, and she was diagnosed with low-flow CSDAVF.…”

Section: Discussionmentioning

confidence: 83%

Bilateral cavernous sinus dural arteriovenous fistula with initial ocular symptom

Zhang

Xu²,

Sun³

et al. 2021

Medicine

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Rationale: Cavernous sinus dural arteriovenous fistula (CSDAVF) is a rare intracranial vascular malformation. Because of its complicated clinical manifestations, it is easy to miss or misdiagnose CSDAVF.Patient concerns: A 42-year-old female had chief complaint that the right eyeball had conjunctival congestion for half a year. She was given levofloxacin eye drops to treat the right eye with anti-inflammatory treatment, but the symptoms did not improve. Cranial magnetic resonance and cerebrovascular imaging showed that the right lateral rectus muscle was slightly enlarged, the right eyeball was prominent, but there was no abnormality in the brain.Diagnoses: Based on clinical and imaging examinations and digital subtraction angiography (DSA), she was diagnosed as lowflow CSDAVF. Interventions:The patient received interventional embolization with transvenous combined arterial approach using coils and Onyx liquid glue.Outcomes: The patient's exophthalmos and congestion symptoms were improved.Conclusion: DAS is the gold standard for the diagnose of CSDAVF. Intravascular embolization interventional therapy is an effective treatment for CSDAVF.

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“…Given the diagnostic challenge that a CCF can present ( 1 – 3 , 5 , 14 , 15 ), the invasiveness of angiography and the propensity for spontaneous resolution ( 4 , 16 , 17 ), rapid non-invasive diagnostics are desirable for diagnosis and for differentiating an active fistula from one that is thrombosing. Goldmann applanation tonometry of the affected eye often reveals a significant change of IOP between systole and diastole during the cardiac cycle.…”

Section: Introductionmentioning

confidence: 99%

Retinal arterial–venous pulse delay: a new specific marker for a carotid–cavernous fistula

Linton,

Tedeschi,

Ahmad

et al. 2023

Front. Ophthalmol.

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PurposeThe purpose of the study was to describe ocular blood flow changes in eyes affected by a carotid–cavernous fistula (CCF) using laser speckle flowgraphy. We hypothesized that imaging blood flow velocity waveforms in the retinal arterioles and venules simultaneously would reveal specific characteristics of an arteriovenous (AV) connection.DesignThe study was an observational case series, with a retrospective case–control analysis.MethodsFive patients with a CCF underwent measurement of ocular blood flow using laser speckle flowgraphy. The blood flow was compared retrospectively between a control group of healthy subjects (n = 32) and patients with an elevated intraocular pressure or venous outflow impairment without an AV fistula (n = 40). The outcomes were derived from the arteriole and venule blood flow velocity waveforms, including an A–V phase delay and flow pulsatility.ResultsThe presence of an active CCF was associated with an increased delay in the peak velocity measured in the retinal venule (10.7% ± 2.2% of the cardiac cycle duration) compared with unaffected fellow eyes (1.8% ± 0.2%; p = 0.05) or control eyes of normal subjects (2.7% ± 0.3%; p = 0.02). This delay disappeared after fistula thrombosis and was not present in eyes with a central retinal vein occlusion (CRVO), glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), or papilledema. The venule blood flow velocity decreased during systole (and in some cases momentarily stopped), leading to a delayed pulse with a greater amplitude in the venules than in fellow eyes and normal controls after normalizing to the arteriole amplitude (1.71 ± 0.3 vs 0.54 ± 0.03 vs 0.59 ± 0.02; p = 8.0E-12). This specific AV delay could also be identified in a scanning laser ophthalmoscope (SLO; SPECTRALIS®) video.ConclusionLaser speckle flowgraphy reveals dynamic retinal vascular changes in eyes affected by a CCF, which are not present in healthy controls or patients with other eye conditions, and which reverses with treatment.

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Treatment of low flow, indirect cavernous sinus dural arteriovenous fistulas with external manual carotid compression – the UK experience

Cited by 5 publications

References 18 publications

Role of surgery in management of intracranial dural arteriovenous fistulas

Role of surgery in management of intracranial dural arteriovenous fistulas

Bilateral cavernous sinus dural arteriovenous fistula with initial ocular symptom

Retinal arterial–venous pulse delay: a new specific marker for a carotid–cavernous fistula

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