Diagnosis Of Carotid-cavernous Fistula Research Articles

DIRECT CAROTID CAVERNOSUS FISTULA

Abstract
 Introduction : Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system, most commonly due to head trauma from a basal skull fracture creating a tear in the internal carotid artery (ICA) within the cavernous sinus.
 Case Illustration : A 15 years old girl presented with orbital pain, swelling, swishing or buzzing sounds, headache, and vision loss. Five months ago, she had a history of traumatic injury and undergone craniotomy. From physical examination Orbital ultrasound presence with dilated superior ophthalmic vein, which appears as a hollow tubular structure with no internal echo. MRI scan show a mass suggestive carotid cavernosus fistula dextra. DSA result confirmed the diagnose as direct carotid cavernosus fistula dextra as communication between internal carotid artery and sinus cavernosus. The patient was treated with neuroprotective along medication followed by endovascular treatment from the neurointervention department.
 Discussion : The classic triad of CCF includes pulsatile exophthalmos, chemosis and orbital bruit. Ophthalmic manifestations of CCFs vary widely depending on underlying aetiology, type, size, location, blood flow rate and drainage route of the CCF. Patient initially undergo noninvasive imaging with orbital ultrasound and magnetic resonance imaging (MRI). Digital subtraction angiography is the gold standard in the diagnosis of CCF and must be performed before any potential intervention.
 Conclusion : This case describes a patient who was diagnose with direct carotid cavernous fistula of the right eye.

Carotid Cavernous Fistula with Central Retinal Vein Occlusion

Purpose: To report a rare case of slow progression of carotid cavernous fistula (CCF) with central retinal vein occlusion (CRVO).Case summary: A 66-year-old man presented with conjunctival injection and proptosis in the right eye. Best-corrected visual acuity was 0.8 and 0.5 in the right and left eye, respectively, and conjunctival vessel enlargement and subconjunctival hemorrhage were observed in the right eye on slit lamp examination. Due to suspicion of CCF, computed tomography, computed tomography angiography, magnetic resonance imaging, and magnetic resonance angiography were performed. These analyses showed no vascular abnormalities associated with arteriovenous shunt, so the patient was followed up closely. About 1 month later, his conjunctival vessel engorgement became severe and CRVO derived from venous stasis by CCF occurred, so transfemoral cerebral angiography was performed and a diagnosis of CCF was made. Intravitreal anti-vascular endothelial growth factor injection was performed for CRVO, and best corrected visual acuity improved to 1.0 in the right eye.Conclusions: Slowly progressing CCF can be accompanied with rare intraocular disease, such as CRVO, so appropriate diagnosis through detailed evaluation is important for treatment.

Venous Stasis Retinopathy Complicating a Case of Cavernous-carotid Fistula with an Initial Normal Computed Tomography Angiogram of the Brain

Carotid-cavernous fistula (CCF) can be spontaneous or due to trauma. Due to its complication to the eye, diagnosis and intervention should not be delayed. We report a case of an elderly female who presented with left eye redness with gradual onset of protrusion over the same eye. She was suspected to have CCF with the clinical presentation. Nevertheless, she had a normal computed tomography angiogram of the brain. Later, she was scheduled for cerebral angiography and the diagnosis of CCF was confirmed. However, due to delay in diagnosis and treatment, the patient developed venous stasis retinopathy and neovascular glaucoma. Her vision remained poor despite aggressive systemic and ocular treatments. This case report is to emphasise the importance of clinical suspicion of a disease despite a normal imaging. This is to prevent irreversible blindness and other systemic complications.

Carotid-Cavernous Fistula Presenting With Bilateral Abducens Palsy.

Carotid-Cavernous Fistula Presenting With Bilateral Abducens Palsy.

Диагностика каратидно-кавернозного соустья в офтальмологической практике

Диагностика каратидно-кавернозного соустья в офтальмологической практике

Carotid Cavernous Fistulas and Dural Arteriovenous Fistulas of the Cavernous Sinus: Validation of a New Classification According to Venous Drainage

Multiple carotid cavernous fistula (CCF) classifications have been proposed. However, they lacked predictive factors for the clinical presentation, natural history, and hemorrhagic risk. Our aim was to externally validate a new classification according to venous drainage (i.e., the Thomas classification [TC]) to assess its relationship with symptoms, endovascular treatment, and outcomes. We performed a multicenter retrospective review of CCFs at 2 major academic institutions. The CCFs were classified using the Barrow classification (BC) and TC systems. The data from 94 patients with a diagnosis of CCF were collected during a study period 23 years, 4 months. Of these 94 patients, 89 had undergone CCF treatment and 5 had experienced spontaneous occlusion. Complete occlusion was achieved in 89.9% of the treated patients. Complications occurred in 5.3% of the patients, including permanent deficits in 2.1%. TC type 4 was associated with cortical symptoms compared with type 2 (P= 0.003) and type 3 (P < 0.001). The BC was not able to detect significant differences among the symptom types. Significant differences were found using the TC for the transarterial-only, transvenous anterior-only, and transvenous posterior-only approaches (P < 0.001, P= 0.03, and P= 0.001, respectively). The transvenous posterior and transvenous anterior approach were significantly associated with type 2 and 3 TC, respectively. Excluding direct CCFs, the BC was not related to the treatment approach. No significant differences in the outcomes were found. However, a trend toward a lower occlusion rate for TC type 4 compared with type 3 was observed. The TC provided useful information regarding the fistula anatomy and venous hemodynamics, which correlated with the clinical symptoms and treatment strategy.

Choroidal thickening in a case of carotid cavernous fistula

ABSTRACTA 47-year-old woman was diagnosed with dural carotid cavernous fistula (CCF) in her right eye (RE). Scans of the choroid using Spectralis optic coherence tomography (OCT) demonstrated significant asymmetry in subfoveal choroidal thickness (RE 451 μm, left eye (LE) 367 μm). This asymmetry disappeared after the fistula was embolizated through the ophthalmic artery (RE 341 μm; LE 340 μm). This case suggests that OCT should be considered as an ancillary test in the diagnosis of CCF.

Efficacy of Orbital Color Doppler Imaging and Neuroimaging in the Diagnosis of Carotid Cavernous Fistulas.

To evaluate the diagnostic sensitivity and specificity of orbital color Doppler imaging (CDI) and conventional neuroimaging (CT/MRI) compared with cerebral angiography in patients with carotid-cavernous fistulas (CCFs). The study design was a retrospective patient chart and imaging review. The authors reviewed 655 charts of all patients who underwent CDI and neuroimaging (CT/MRI) between 2006 and 2015 at one institution. Sixty patients had a presumptive diagnosis of CCF without thrombosis. Thirty-seven patients with 43 events met the inclusion criteria of the study. The diagnostic sensitivity of the 3 noninvasive imaging modalities (CDI, CT, MRI) for CCF was compared with the gold standard 6-vessel cerebral angiography. Significance testing was performed using the 2-tailed Fisher test. Color Doppler imaging had high sensitivity (96.8%) but low specificity (41.7%) for the diagnosis of CCFs with anterior orbital findings. A negative CDI had more diagnostic value than a positive CDI. While an arterial wave form in the superior ophthalmic vein was the most common finding of CCF on CDI, enlargement of the superior ophthalmic vein was the only statistically significant finding. Posterior cortical venous drainage was noted in about 10% of the patients with indirect (low-flow) fistulas, who presented with unilateral orbital signs and symptoms, a finding not previously reported in the literature. Color Doppler imaging is a useful noninvasive, radiation-free modality for diagnosis of CCF with anterior drainage, with higher sensitivity than CT or MRI, but equivalent specificity. A significant limitation of CDI is the lack of usefulness in diagnosing fistulas with posterior cortical venous drainage, which carry a risk of intracerebral hemorrhage and stroke. In this series, 10% of unilateral CCFs with anterior orbital signs and symptoms showed angiographic evidence of posterior cortical venous drainage.

Orbital color Doppler ultrasound as noninvasive tool in the diagnosis of anterior-draining carotid-cavernous fistula.

To investigate the role of orbital color Doppler ultrasound (OCDUS) in the diagnosis of carotid-cavernous fistula (CCF) with anterior drainage and particularly whether a negative OCDUS could avoid an invasive diagnostic cerebral angiography (DSA). Twenty-two consecutive patients with ophthalmic signs suspecting CCF were submitted to ophthalmologic examination, OCDUS and DSA. CCF diagnosis with OCDUS was based on the finding of a reversed, arterialized and low-resistive-index (RI <0.5) blood flow in the superior ophthalmic vein (SOV). Sensibility, specificity, PPV, NPV, and accuracy of OCDUS were calculated considering both patients and eyes, using DSA as gold standard. DSA demonstrated 20 CCFs in 18 patients. Considering the patients, in 18/22 CCF diagnosis was positive at OCDUS and DSA while 4/22 were negative at both. Considering the eyes, in 24/43 CCF diagnosis was positive at both DSA and OCDUS (total eyes=43, due to one case of SOV thrombosis). In 19/43 eyes diagnosis was negative at both OCDUS and DSA. So sensitivity, specificity, PPV, NPV, and accuracy of OCDUS in the patients and eyes analysis were all 100%. OCDUS is a reliable, noninvasive tool in the diagnosis of CCF; a negative OCDUS could avoid an invasive DSA in patients suspected for anterior-draining CCF.

Venous drainage patterns in carotid cavernous fistulas.

Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.

Opis przypadu Późna manifestacja pourazowej przetoki szyjno-jamistej –

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Roskal-Wałek J, Biskup M. Post-traumatic carotid cavernous fistula of late manifestation report. Medical Studies/Studia Medyczne. 2014;30(4):265-270. doi:10.5114/ms.2014.47926. APA Roskal-Wałek, J., & Biskup, M. (2014). Post-traumatic carotid cavernous fistula of late manifestation report. Medical Studies/Studia Medyczne, 30(4), 265-270. https://doi.org/10.5114/ms.2014.47926 Chicago Roskal-Wałek, Joanna, and Michał Biskup. 2014. "Post-traumatic carotid cavernous fistula of late manifestation report". Medical Studies/Studia Medyczne 30 (4): 265-270. doi:10.5114/ms.2014.47926. Harvard Roskal-Wałek, J., and Biskup, M. (2014). Post-traumatic carotid cavernous fistula of late manifestation report. Medical Studies/Studia Medyczne, 30(4), pp.265-270. https://doi.org/10.5114/ms.2014.47926 MLA Roskal-Wałek, Joanna et al. "Post-traumatic carotid cavernous fistula of late manifestation report." Medical Studies/Studia Medyczne, vol. 30, no. 4, 2014, pp. 265-270. doi:10.5114/ms.2014.47926. Vancouver Roskal-Wałek J, Biskup M. Post-traumatic carotid cavernous fistula of late manifestation report. Medical Studies/Studia Medyczne. 2014;30(4):265-270. doi:10.5114/ms.2014.47926.

Clinical value of dual-energy CT angiography in the diagnosis of carotid cavernous fistula

Objective To explore the clinical value of dual-energy CT angiography (DE-CTA) in the diagnosis of carotid cavernous fistula. Methods Fourteen patients suspected of carotid cavernous fistula underwent DE-CTA between Dec. 2008 and Feb. 2010. Image post-processing of DE-CTA was performed with the dedicated software to obtain bone-removal and non bone-removal images. Four experienced radiologists evaluated image quality of DE-CTA, the number, location and size of fistulae and dilation of cerebral veins. The bone-removal and non bone-removal images were compared for displaying of fistulae and other related lesions. Kappa test was used to test the consistency of image quality evaluation between two radiologists. The sizes of fistulae were measured with bone-removal DE-CTA images and non bone-removal DE-CTA images respectively and their results were compared by using student's t-test and the correlation test. Results Twenty-eight intracranial internal carotid arteries of 14 patients showed acceptable image quality. Fourteen cases were diagnosed as carotid cavernous fistula with both bone-removal and non boneremoval DE-CTA images. Two patients presented with bilateral lesions, while 7 patients presented with left lesions and 5 patients had right lesions. Totally, sixteen fistulae lesions were detected in 14 patients. The mean size of fistulae was (0. 36 ±0. 10) mm by bone-removal images, whereas (0. 35 ±0. 11 ) mm by non bone-removal images. There was no significant difference between the two methods ( t = 0. 29, P ＞ 0. 05 ),and good correlation was found between the two methods ( r = 0. 97, P ＜0.05). Thirteen dilated cerebral veins in 8 cases were found by bone-removal images versus 9 dilated cerebral veins in 6 cases by non boneremoval images. Conclusions Image post-processing of DE-CTA is a simple and useful method to identify carotid cavernous fistula. DE-CTA is also useful for therapeutic planning. Key words: Carotid-cavernous sinus fistula; Tomography,X-ray computed; Image processing,computer-assisted

Fistules carotidocaverneuses : présentation clinique, prise en charge et diagnostics différentiels

Carotid-cavernous fistulas are abnormal communications between the carotid system and the cavernous sinus. Depending on their direct or indirect nature, they have different clinical manifestations and management. Are discussed in this paper: first the anatomy of the cavernous sinus, then clinical signs, diagnosis, management and differential diagnosis of carotid-cavernous fistulas.

Vein of Galen Aneurysmal Malformation Masquerading as Carotid Cavernous Fistula in a Child with Proptosis

An infant with proptosis and dilated episcleral vessels was diagnosed with vein of Galen malformation, which is a rare condition presenting initially to an ophthalmologist. An 8-month-old child presented with slowly progressive proptosis of the left eye of 5 months' duration. The proptosis was axial, nonpulsatile, with no associated bruit. Dilated corkscrew episcleral vessels were observed. The patient was referred to our center with diagnosis of carotid cavernous fistula. The child had a history of episodes of seizures. Contrast-enhanced computed tomographic scan of the patient showed dilated vessels, hydrocephalus, and dilated vein of Galen. Vein of Galen aneurysmal malformation was confirmed on magnetic resonance venography. Occasionally patients with Vein of Galen aneurysmal malformation may first present to the ophthalmologist. Ophthalmologists should therefore be aware of this rare but potentially treatable condition.

MRI diagnosis of carotid cavernous fistula: a report of 12 cases

目的 分析颈动脉海绵窦瘘(CCF)的MRI表现及诊断价值.方法 搜集近年有完整临床资料的CCF 12例进行MRI表现的回顾性分析.其中男8例,女4例;外伤性CCF 11例,自发性1例,均由DSA造影证实.结果 MRI主要表现为:(1)眼球突出11例;(2)海绵窦扩大12例;(3)眼上静脉扩张、迂曲 11例,蝶顶窦和大脑中、浅静脉扩张2例,岩上窦和岩下窦扩张2例,眼下静脉和眼睑静脉扩张 1例;(4)眼外肌增粗3例;(5)脑萎缩3例,脑水肿和脑出血2例.结论 MR检查是一种无创伤的诊断CCF的方法,具有准确、方便、特异性高等优势,能明确病变部位及程度,但应进行必要的鉴别诊断。

Imaging diagnosis of carotid cavernous fistula

To evaluate the value of ultrasonography, CT, MRI and digital subtraction angiography (DSA) in the diagnosis of carotid cavernous fistula (CCF). Twenty-eight cases of CCF patients were examined with ophthalmologic A/B echography and DSA, part of them were examined by one or several items among color Doppler imaging, CT and MRI. Ultrasonography could determine the enlarged ophthalmic vein with signal of blood stream and could detect the pulsation synchronizing with the pulse. CT and MRI could display the enlargement and abnormality of cavernous sinus. DSA could reveal fistulas supplied by internal carotid artery directly or by the dual branches of the carotid artery. The latter included meningohypophyseal trunk, capsular artery, middle meningeal artery, accessory meningeal artery, ascending pharyngeal artery and the artery of the foramen rotundum, etc. The drainage pathway of fistula included ophthalmic vein, inferior petrosal sinus, intercavernous sinus, sylvian vein and cortical drainage, etc. Each method of examination has its own advantages, combining of various methods can lead to an accurate diagnosis of CCF. DSA is the "golden standard" which can display supplying artery and the drainage pathway.

Fístulas carotidocavernosas directas: tratamiento endovascular mediante balón desprendible

Carotid cavernous fistulas are abnormal communications between the cavernous sinus and the internal and/or external carotid artery. They may be spontaneous or acquired. Two basic types are distinguished as a function of the aetiology, clinical features and treatment. The direct type is usually due to trauma while the indirect is of varied aetiology.We present a series of seven cases of direct carotid-cavernous fistulas, four post-traumatic and three spontaneous, with initial symptoms of ocular involvement and ophthalmoparesia predominantly. All were treated, in our hospital, by embolization with a detachable balloon in the venous variant of the fistula in six cases and by carotid occlusion in one case. Only one severe complication due to distal embolization occurred.It is necessary to consider the diagnosis of carotid-cavernous fistulas in patients complaining of acute alterations of ocular motility, headache and/or other ocular symptoms, especially when there is a clinical history of head injury. There should be minimal delay between diagnosis and treatment since there is a high risk of hemorrhage and irreversible sequelae caused by alteration of the venous drainage when they are long-standing. The treatment of choice for direct fistulas is by detachable balloon, which has been shown to be superior to other techniques.

Diagnosis of carotid-cavernous fistula by periorbital color Doppler imaging and pulsed Doppler volume flow analysis.

Diagnosis of carotid-cavernous fistula by periorbital color Doppler imaging and pulsed Doppler volume flow analysis.