If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can. Ruptured cavernous sinus aneurysms causing carotid cavernous. The diagnosis of a ccf is readily made on catheter angiography by the demonstration of abnormal arteriovenous shunting into the cavernous sinus from either the ipsilateral cavernous ica or meningeal branches to the sinus wall in the case of an indirect fistula. Feb 10, 2017 the fistula was supplied most prominently from the bilateral external carotid arteries and showed prominent retrograde drainage into the dilated left superior ophthalmic vein. Carotid cavernous fistula ccf is the abnormal communication between the internal carotid artery and the cavernous sinus.
This frontal view shows the enlarged left carotid cavernous sinus fistula right compared to the normal right cavernous sinus left. As a result, the blood can drain properly from the eyes. Ruptured cavernous sinus aneurysms causing carotid. Carotidcavernous sinus fistulas and venous thrombosis. Carotidcavernous fistulae are a specific kind of dural fistula that involves the carotid artery or its branches and a large vein cavernous sinus behind the eye.
Multiple venous drainage pathways are illustrated, including the left superior petrosal sinus thin black arrows, left inferior petrosal sinus thick black arrows, right. The carotid cavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. The potentially sightrobbing vascular abnormality known as the carotid cavernous sinus fistula ccf can masquerade as conjunctivitis or other common ocular conditions, which diminishes the chance for a speedy diagnosis. A 45yearold caucasian male presented to the emergency department of. If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can eventually lead to blindness. These lesions may be classified based on the following. Panel b shows a postguglielmi detachable coil, ie, coiling of the fistula. What is a carotid cavernous fistula doctor answers. This article is from june 2005 and may contain outdated material. Caroticocavernous fistula radiology reference article. A caroticocavernous fistula ccf may be due to either a direct connection between the cavernous ica and the cavernous sinus and present acutely, or due to an indirect connection via small branches of.
Highflow direct ccfs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. The difference in the blood pressure between the arteries and the veins behind the eye leads to a buildup of blood in a persons eye. Cavernous sinus or its dura the thin membrane that covers the cavernous sinus. Venous drainage patterns in carotid cavernous fistulas. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. A carotid cavernous sinus fistula ccf is an arterialvenous fistula between the internal carotid artery and cavernous sinus, and can be classified as either direct or indirect. The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. The coils also might exert mass effect and result in cranial nerve injury. Spontaneous carotid cavernous fistula in a case with protein s deficiency that newly developed ophthalmoplegia after embolization. To our knowledge, this is the first report of the ct angiographic appearance of carotid cavernous fistulas. The treatment of a carotid cavernous fistula ccf depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. A 45yearold caucasian male presented to the emergency department of a tertiary care. Highflow direct ccfs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a.
Four cases in which the diagnosis of carotidcavernous fistula was made by using ct angiography are illustrated. A carotidcavernous fistula ccf is an abnormal communication between arteries and veins within the cavernous sinus and may be classified. A carotid cavernous fistula is an abnormal connection between the blood vessels in the brain. Trauma, aneurysm or vascular disease can create a carotid cavernous fistula. Full text full text is available as a scanned copy of the original print version. Ccfs are classified into two main types based on their pathophysiology, direct type a and indirect type bd 1, 2, as shown in figure 1. Carotid cavernous fistulas ccf are acquired pathological direct shunts from the cavernous portion of the internal carotid artery ica into the enveloping cavernous sinus fig. Images in clinical medicine from the new england journal of medicine carotid cavernous fistula. Carotid cavernous fistula definition of carotid cavernous. Barrow classification of carotidcavernous fistulas wikicns. Carotidcavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. The diagnosis was confirmed by digital subtraction angiography in all four instances. The carotidcavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach.
Fractures or the shearing forces of severe head trauma. Apr 25, 2020 carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Dural carotidcavernous fistulas neurosurgery clinics of north. Carotidcavernous fistula and carotid artery aneurysm sonoworld. Over the years, numerous classifications have been applied to ccfs. Symptoms include bulging eye, deteriorating vision and ringing in the ears. A ccf can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal. But treatment success rates for these fistulas now approach 100 percent when the repairs are performed early by experienced. The classic signs of a carotidcavernous fistula, including sudden onset of pulsating exophthalmos, a prominent bruit behind the affected eye, marked venous congestion and chemosis, impaired eye movement, and reduced visual acuity were present only in the patient with a traumatic direct internal carotidcavernous sinus fistula case 8. Pdf carotidcavernous fistula in the emergency department.
Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Carotidcavernous fistula definition of carotidcavernous. A carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull. Carotid cavernous fistula adventhealth neuroscience.
Meyer the term carotid cavernous fistula ccf refers to an abnormal communication between the internal carotid artery ica or one of its branches or the external carotid artery eca and the cavernous sinus cs. The characteristic clinical features seen in patients with ccfs are. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. These arteriovenous av shunts can develop spontaneously, but the overwhelming majority 80% are the result of a traumatic injury to the ica or a branch artery. Direct puncture of the cavernous sinus for obliteration of a recurrent carotidcavernous fistula. Carotid cavernous fistulae are a specific kind of dural fistula that involves the carotid artery or its branches and a large vein cavernous sinus behind the eye.
A caroticocavernous fistula ccf may be due to either a direct connection between the cavernous ica and the cavernous sinus and present acutely, or due to an indirect connection via small branches of the ica, eca, or as in this case both. Treatment of carotid cavernous fistulas northwestern. Carotid cavernous fistulas ccfs are abnormal connections between the blood vessels that take blood to and from the brain. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. This separates the blood flow of the carotid arteries from that of the veins. A carotidcavernous sinus fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. This article is from march 2008 and may contain outdated material. A carotidcavernous sinus fistula is an abnormal connection that forms between a carotid artery in your neck and the network of veins at the back of your eye. Carotid cavernous fistulas can be first classified by whether they are traumatic including iatrogenic or spontaneous.
These fistulae can occur because of trauma, if there is an aneursym in the carotid that breaks and causes the communication, or they can happen spontaneously without a definite reason. In the event that the balloon cannot be fed through the fistula via a transarterial approach, detachable platinum coils are often deployed electrolytically via a. In addition, brain arteriovenous malformation avm, 7. Hirai t, korogi y, baba y, nishimura r, hamatake s, kawanaka k, bussaka h, takahashi m. Craniofacial trauma is a major factor for this complication. Treatment of carotid cavernous fistulas northwestern scholars.
As arterial blood under high pressure enters the cavernous sinus, the normal venous return to the cavernous sinus is impeded and this causes engorgement of the. A healthy 18yearold man was in a motor vehicle accident and received. Spontaneous carotidcavernous fistulas are classified into the following groups. Carotid cavernous fistula tytle and punukollu 105 coil disadvantages include the need to pack numerous coils to slow the fistula adequately to allow thrombosis to occur, unlike the direct and often immediate closure with balloon placement. In direct fistulas there is an abnormal communication between the internal carotid artery and the cavernous sinus. A ccf can be due to a direct connection between the cavernous segment of.
Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. In most instances, endovascular treatment is preferred. Caroticocavernous fistulas ccfs occur due to an abnormal communication between the highpressure carotid artery system and the relatively. The red arrow points to coils within the cavernous and circular sinuses after obliteration of. A case of communicating carotid cavernous sinus fistula ccf after minor closed head injury is presented. External manual carotid compression is a noninvasive method to treat cavernous sinus cs dural arteriovenous fistulae davf. Pdf carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. The traumatic fistulae occur more frequently, 75% of cases, appearing after car accidents or after. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. The patient was urgently referred to neurointerventional radiology for diagnostic angiography and. The term carotidcavernous fistula ccf refers to an abnormal communication between the internal carotid artery ica or one of its branches or the external carotid artery eca and the cavernous sinus cs. A case of communicating carotidcavernous sinus fistula ccf after minor closed head injury is presented. Doctor answers on symptoms, diagnosis, treatment, and more. To our knowledge, this is the first report of the ct angiographic appearance of carotidcavernous fistulas.
Ctaguided outflowtargeted embolization of direct carotidcavernous fistula duration. Four cases in which the diagnosis of carotid cavernous fistula was made by using ct angiography are illustrated. The shunting of the blood may produce ocular ischemia 503 and may transmit. Traumatic carotid cavernous fistula accompanying basilar skull fracture. Diagnosis and management of carotid cavernous fistulas. Aneurysms of the cavernous segment of the internal carotid artery usually become symptomatic by mass effect on the adjacent cranial nerves, causing ophthalmoplegia and, sometimes, decreased vision or trigeminal neuralgia. Carotidcavernous fistula an overview sciencedirect topics.
Carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Direct high flow shunt between ica and cavernous sinus. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. Panel a is an angiogram of caroticocavernous fistula showing filling of the cavernous and circular sinuses. A carotid cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. The carotid artery, the main supply to the head, can establish a direct connection to the veins in the cavernous sinus lead to pronounced elevation of pressure in the veins which will dilate throughout the front of the head and can lead to a deadly leak.
Spontaneous carotidcavernous fistula and the ehlersdanlos syndromes. The classic signs of a carotid cavernous fistula, including sudden onset of pulsating exophthalmos, a prominent bruit behind the affected eye, marked venous congestion and chemosis, impaired eye movement, and reduced visual acuity were present only in the patient with a traumatic direct internal carotid cavernous sinus fistula case 8. A ccf can be due to a direct connection between the. Presentation and treatment of carotid cavernous aneurysms. Get a printable copy pdf file of the complete article 2. The fistula was supplied most prominently from the bilateral external carotid arteries and showed prominent retrograde drainage into the dilated left superior ophthalmic vein. This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit, as depicted in the diagram below. Links to pubmed are also available for selected references. Chapter 390 carotid cavernous fistulas giuseppe lanzino, fredric b. Treatment of carotid cavernous fistulas springerlink. A carotidcavernous fistula ccf is an abnormal communication between the carotid artery and the cavernous sinus, which is characterized by increased episcleral venous pressure and decreased arterial blood flow to the cranial nerves within the cavernous sinus. A ccf can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external. Carotidcavernous fistulas provide a free communication between the internal carotid artery and the surrounding cavernous sinus, resulting in high blood flow and high mean pressure in the shunt. Classification and treatment of spontaneous carotid cavernous sinus fistulas.
Carotidcavernous sinus fistula, cerebral angiography, therapeutic embolization, balloon occlusion. A carotid cavernous sinus fistula is an abnormal connection that forms between a carotid artery in your neck and the network of veins at the back of your eye. Carotidcavernous sinus fistula in penetrating facial trauma. Early diagnosis of this rare vascular complication can preserve vision. Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Blood can leak into the sinus cavity and destroy sensitive, surrounding tissue if a blood vessel bursts. Oct 28, 2015 a caroticocavernous fistula results in highpressure arterial blood entering the lowpressure venous cavernous sinus. May 08, 2020 a carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull. Carotid cavernous fistulas have been classified according to the hemodynamic. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus.