Carotid Artery-cavernous Sinus Fistula Research Articles

A retrospective observation study for the diagnostic effect of dual-source CT angiography on traumatic subarachnoid hemorrhage patients

Identification of potential cerebrovascular disorder in the patient with traumatic subarachnoid hemorrhage (tSAH) is a key element to decrease the complication occurrence and mortality rate. In this study, we aim to compare the diagnostic values between dual-source computed tomography angiography (DSCTA) and traditional tomography angiography (CTA) in identification of potential cerebrovascular disorder among tSAH patients. A total of 113 tSAH patients with the hemorrhage involving more than 2 cisterns were recruited. Among that, 42 patients received DSCTA scans, and another 71 patients received traditional CTA scans. Subsequently, all patients received digital subtraction angiography (DSA) tests to confirm the presence of the cerebrovascular disorder. In DSCTA scan group, 21.4 % (9/42) patients were reported to have cerebrovascular disorders: seven patients had intracranial aneurysms; a patient had pseudoaneurysm with carotid artery cavernous sinus fistula; and a patient had Moyamoya disease. DSA tests had the same results with that with DSCTA scans. In the cohort receiving CTA scans, 19.7 % (14/71) patients were reported to had intracranial aneurysms. However, the positive results of DSA tests for this cohort were 22.5 % (16/71). Two inconsistent results between the CTA scan and DSA test were found, including an arteriovenous malformation and an arteriovenous fistula. In summary, DSCTA and CTA had similar positive rates but differ in diagnostic accuracy for identification of cerebrovascular disorders in tSAH patients.

Hybrid treatment for symptomatic long-segment chronic internal carotid artery occlusion without stump

Objective To summarize the preliminary experience of hybrid operation for the treatment of symptomatic long-segment chronic internal carotid artery occlusion (CICAO) without stump. Methods Clinical data of 12 patients of symptomatic long-segment CICAO without stump undergoing hybrid operation treatment from July 2015 to December 2017 were retrospectively analyzed. The safety and efficacy of hybrid operation for the treatment of symptomatic long-segment CICAO without stump were preliminarily assessed. CICAO was defined as occlusion time being more than 4 weeks. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after hybrid operation within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. Results In this group, the symptomatic long-segment CICAO of 11 patients were successfully recanalized. Technical success rate was 91.7% (11/12). The main complication rate was 8.3% (1/12). This patient encountered iatrogenic internal carotid artery cavernous sinus fistula caused by micro-guide wire in the midway of the hybrid operation, the proximal segment of this internal carotid artery was ligated and the iatrogenic internal carotid artery cavernous sinus fistula disappeared in the following digital subtraction angiography image. No patient encountered hemorrhagic stroke and ischemic stroke. No death complications occurred. In this group 10 patients of them were followed up. The follow-up period ranged from 10 to 32 months [mean, (19±9) months]. During the follow-up period, 1 patients developed in-stent restenosis and improved after reoperation of percutaneous transluminal angioplasty by the right size balloon without stenting treatment. Conclusion Hybrid operation for the treatment of highly screened patients with symptomatic long-segment CICAO without stump is safe and effective, could reduce the incidence of complications and improve procedural success rate.

The diagnosis and treatment of traumatic optic nerve neuropathy combined with carotid artery injury

Objective: To discuss the diagnosis and treatment strategy of traumatic optic nerve neuropathy (TON) combined with carotid artery injury. Methods: Retrospective analyses were performed 397 cases of TON at Neurosurgery department of Beijing Tongren Hospital, Capital Medical University (CMU), from January 2016 to December 2017.The clinical experience was concluded. Results: 9 cases of Traumatic Pseudo Aneurysm (TPA) and 16 cases of Traumatic Carotid Artery-Cavernous Sinus Fistula (TCCF) were found.7 cases of TPA were treated by covered stent, the other 2 cases were treated by detachable balloons.11 cases of TCCF were treated by detachable balloons, and 5 cases of fistulas were found spontaneously closed by DSA after 1-3 months.There was no disability rate and mortality in this study. Conclusion: TON combined with carotid artery injury was a critical situation, and sometime without obvious symptoms and sign, which was easily miss diagnosed.It should be with more concern in diagnosing and treating in such cases, to avoid disability rate and mortality.

A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery–cavernous sinus fistula

Authors present the case of a patient with a direct carotid artery-cavernous sinus fistula caused by head trauma in whom a self-expanding covered stent was successfully used to obliterate the fistula. However, at the 9-month follow-up an angiogram revealed a complex caroticocavernous fistula that was completely obliterated with Onyx 18 transarterially.

Traumatic carotid artery–cavernous sinus fistula treated with a covered stent

The authors describe the cases of two patients with unilateral traumatic caroticocavernous fistulas in whom a self-expanding covered stent was successfully used to obliterate the fistula after failed occlusion with detachable balloons and coils. They discuss this option as a primary therapeutic modality in cases in which detachable balloons or coils, with or without a bare stent, have failed to obliterate the fistula. The placement of a covered stent to occlude the lesion from the outset may represent a new therapeutic approach to the treatment of these lesions.

Preocclusive Carotid Artery Thrombosis: Pathogenesis and Management

In this report, the authors review the presentations, angiographic findings, and outcomes of eight cases involving patients who had atherosclerotic compromise of the proximal internal carotid artery and were developing distal thrombosis. They discuss the pathogenesis and implications of such lesions and review the management strategy used at this institution. Between 1994 and 1995, 606 consecutive patients underwent carotid endarterectomy (CEA) at this institution. Among this group, four consecutive patients (0.66%, 4/606) were identified by angiography to have preocclusive carotid artery thrombosis. An additional four patients with the same radiologic finding who had presented between 1980 and 1993 were also identified and included in this series. All eight patients were treated with anticoagulation and emergent CEA and thrombectomy. Complete resolution of presenting symptoms and freedom from perioperative stroke and death were achieved in seven patients (88%, 7/8). In one patient (12%, 1/8) the perioperative course was complicated by development of a carotid artery-cavernous sinus fistula and stroke. The catastrophic potential of preocclusive carotid artery thrombosis mandates immediate intervention. Anticoagulation, CEA, and thrombectomy can result in freedom from the adverse outcomes of stroke and death. However, special care must accompany thrombectomy in order to avoid complications and their associated morbidity.

Verifying complete obliteration of carotid artery-cavernous sinus fistula: role of color Doppler ultrasonography.

The purpose of this study was to evaluate the role of color Doppler ultrasonography in verifying obliteration of carotid artery-cavernous sinus fistula before and after therapeutic embolization or gamma knife radiosurgery. Before treatment, carotid artery-cavernous sinus fistula showed the following data on color Doppler ultrasonography: (1) increased blood flow in the common carotid artery (220 to 1264 ml/min with mean+/-SD of 728+/-378 ml/min); internal carotid artery (435 to 1097 ml/min with mean+/-SD of 834+/-216 ml/min) in fistulas of the direct type; and external carotid artery (85 to 257 ml/min with mean+/-SD of 170+/-75 ml/min) in fistulas of the indirect type in comparison to the contralateral side; (2) reverse pulsatile flow or spiculated wave form with turbulent flow in the engorged superior ophthalmic vein on the lesion side in all patients. All of the above abnormal hemodynamic changes became normal in six patients immediately after first embolization, in two patients with balloon embolization combined with subsequent direct embolization by direct puncture through the superior orbital fissure or internal carotid artery embolization, and in five patients after gamma knife radiosurgery at 4, 4, 8, 9, and 9 months, respectively. Color Doppler ultrasonography might be a good modality in long-term follow-up of carotid artery-cavernous sinus fistula after gamma knife radiosurgery and embolization.

Naso-ethmoid-orbital fractures.

This report reviews the experience with naso-ethmoid-orbital fractures at a major medical center. Thirty-three patients were treated between 1 October 1976 and 1 January 1979, who met our definition of naso-ethmoid-orbital fractures. The majority sustained trauma in a motor vehicle accident and 60% of the patients had associated nonfacial injuries. All patients had other facial injuries and fractures; orbital rim or floor, 94%; complex maxillary (LeForte II-III), 72%; and mandible fractures, 25%. Slightly over one half of the group of naso-ethmoid fractures were open; the remainder were closed injuries. Traumatic telecanthus was noted in 70% of the patients on initial examination. Cerebrospinal fluid rhinorrhea was evident in 40%, and frontal sinus fractures were detected in 25% of the group. Severe ocular injury with initial or subsequent loss of sight occurred in an alarming 30% of the patients. In addition, nasolacrimal duct system lacerations occurred in 20%. One patient developed a large carotid artery-cavernous sinus fistula 1 month postinjury. The severity of these injuries and the potential for deformity and dysfunction have not been properly emphasized in the past. Our experience has defined several diagnostic and therapeutic guidelines. For example, vastly improved results were obtained with an open reduction and internal fixation procedure. A multidisciplinary approach by a neurosurgeon, ophthalmologist, and plastic surgeon is mandatory.

Nonpulsatile Exophthalmos in Carotid-Cavernous Sinus Fistula

An unusual case of carotid artery-cavernous sinus fistula with pulseless exophthalmos is presented in a two and one-half year old child. Though exophthalmos and increased episcleral venous distention were present, the ophthalmic artery pressure was not significantly altered as determined by ocular pneumoplethysmography. Consequently there was no evidence of hypoxic sequelae which frequently occur with this arteriovenous shunt. The combined use of arteriography and ocular pneumoplethysmography is advocated for determining and characterizing the presence of significant intracranial arteriovenous disease.

Bilateral internal carotid aneurysm involving cavernous sinus; right carotid artery-cavernous sinus fistula and left saccular aneurysm.

BILATERAL aneurysms involving the internal carotid artery in the cavernous sinus are rare and present difficulties in diagnosis and treatment. Among 75 verified aneurysms, only a single instance of such an aneurysm has been encountered. For this reason the case here reported appears to be significant. REPORT OF A CASE Bilateral aneurysm of cavernous sinus; carotid artery-cavernous sinus fistula on right and saccular aneurysm on left. History. —M. L. (J. H. #NH8890), a woman aged 45, was transferred to the Jefferson Medical College Hospital from the service of one of us (I. M. T.) in the Wills Hospital on Dec. 2, 1950. She had been well until about five weeks before admission (Oct. 30), when she suddenly experienced a dizzy spell while undressing for bed. She described this episode as a sinking, swimming sensation, from which she had suffered from time to time in the past. As a result of