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. 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. Signs and symptoms are related to the compression of structures within the cavernous sinus, including the. 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. Following the release of oxygen in the tissues, the blood returns. Caroticocavernous fistula radiology reference article. Endovascular treatment of direct carotid cavernous fistulae. Endovascular treatment of carotid cavernous fistulae. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. To our knowledge, this is the first report of the ct angiographic appearance of carotidcavernous fistulas.
Doctor answers on symptoms, diagnosis, treatment, and more. Study conducted at the pelotas federal university ufpel pelotas rs, brazil. The venous drainage of this compartment is directed into the engorged superior ophthalmic vein red. In patients in whom absolutely no runoff is demonstrated, carotid sacrifice at the level of the carotidcavernous fistula can be considered, if necessary, to close the fistula. Ctaguided outflowtargeted embolization of direct carotid cavernous fistula duration. Patients present with proptosis, ecchymosis redness, and pain around the affected eye. Direct penetrating traumaor intracavernous aneurysmal rupture are other less common causes. Campbell, ddst the cavernous sinuses and associated structures comprise a unique and intricate physioanatomic unit. Treatment of carotid cavernous fistulas springerlink. A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that can cause severe ocular damage. They are classified into dural cavernous sinus fistulae or direct carotidcavernous fistulae. Carotid cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. We evaluated drainage patterns of ccfs by digital subtraction angiography dsa and categorized drainage pathways according to their types and etiology. Imaging diagnosis of dural and direct cavernous carotid fistulae.
The fistula leads to a highpressure inflow of arterial blood into the venous sinuses, resulting in compression and damage to adjacent structures. Increased pressure within the cs seems to be the mainstay of pathophysiology, although arterial steal and increased flow plays an important role. Because of the varied and important structures within the cavernous sinus, serious pathophysiologc changes may result from trauma andor infection of this region. They are postulated to occur secondary to cavernous sinus thrombosis. What is a carotid cavernous fistula doctor answers. 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. 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. Direct carotid cavernous fistulas ccf are communications between the internal carotid artery and the cavernous sinus.
Ophthalmology department, pelotas federal university ufpel medical school pelotas rs, brazil. May 15, 2001 traumatic carotid cavernous fistula tccf arises from head injury and results in a direct shunt between the internal carotid artery ica and the cavernous sinus, which usually occurs in young men. Because the carotid arteries have a greater pressure of blood flow than do the veins, the rush of blood prevents the veins that serve the eyes from draining properly. Carotid cavernous fistula may result from the down fracture of the maxilla or the pterygoid osteotomy, thus injuring the internal carotid artery. They are mostly posttraumatic and due to laceration of the carotid siphon or rupture of its intracavernous branches occurring during abrupt deceleration in traffic accidents 1. Typically, they present as a result of a direct vascular connection between an extracranial branch of the vertebral artery or its radicular components and the epidural venous plexus. Needless to say, this treatment also depends on the collateral vessels and the patients ability to tolerate intracavernous carotid artery sacrifice. To our knowledge, this is the first report of the ct angiographic appearance of carotid cavernous fistulas. This was a prospective cohort study consisting of 60 patients diagnosed with carotid cavernous fistula.
Oct 28, 2015 in patients in whom absolutely no runoff is demonstrated, carotid sacrifice at the level of the carotid cavernous fistula can be considered, if necessary, to close the fistula. 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. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid cavernous fistulae, but it is possible to differentiate one type from the other. Recent advances in endovascular techniques have resulted in several therapeutic modalities becoming available and the endovascular approach has evolved as the primary treatment option for the management of ccfs. Symptoms are often abrupt in onset and rapidly progressive, and ccf requires immediate treatment if there is progressive visual impairment. Images in clinical medicine from the new england journal of medicine carotid cavernous fistula. 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. Carotidcavernous fistula may result from the down fracture of the maxilla or the pterygoid osteotomy, thus injuring the internal carotid artery. Ruptured cavernous sinus aneurysms causing carotid cavernous. Create marketing content that resonates with prezi video. Carotid cavernous sinus fistulas ccfs are abnormal communications between the carotid arterial system and the cavernous sinus. Ccfs can be classified by anatomy direct or dural, etiology traumatic or spontaneous or blood flow velocity high or low. A carotid cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. A direct fistula is due to direct communication between the intracavernous internal carotid artery and the surrounding cavernous sinus.
May 08, 2020 a carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull. Carotidcavernous fistula knowledge for medical students. Carotid cavernous fistula joseph niamtu, iii, dds, and robert l. Fractures or the shearing forces of severe head trauma. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. 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. 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. A ccf can be due to a direct connection between the cavernous segment of. A carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. Cavernouscarotid fistula definition of cavernouscarotid. A carotidcavernous fistula is an abnormal communication between a carotid artery and the cavernous sinus. Vertebralvenous fistulas vvf, or vertebralvertebral arteriovenous fistulas, are an uncommon clinical entity. Normally, oxygenated blood flows to the tissue through arteries and capillaries. 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.
The fistula was successfully treated angiographically. These lesions may be classified based on the following. A healthy 18yearold man was in a motor vehicle accident and received. Endovascular treatment of carotid cavernous sinus fistula. Ctaguided outflowtargeted embolization of direct carotidcavernous fistula duration. Carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. The main symptom is diplopia, caused by compression injury of the oculomotor nerves. These veins at the back of your eye transport blood from your face and brain back to your heart and are located in small spaces behind your eyes called cavernous sinuses. 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. 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. It is a rare complication caused by maxillofacial trauma and can lead. Direct carotidcavernous fistulae ccfs are type a fistulae according to barrows classification.
Ccf can be traumatic or spontaneous, with the traumatic type being more common, representing 75% of all ccfs. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. This article is from june 2005 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. A carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull. The diagnosis was confirmed by digital subtraction angiography in all four instances. Arteriovenous fistula definition an arteriovenous fistula is an abnormal channel or passage between an artery and a vein. We also describe the technique, symptomatology and complications associated with the procedure and report on the longterm followup in our treated. The nerve passes inferiorly and laterally, to lie between the internal carotid artery and jugular vein, superficial to the. If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can eventually lead to blindness. In most instances, endovascular treatment is preferred. Four cases in which the diagnosis of carotid cavernous fistula was made by using ct angiography are illustrated. Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can.
Carotidcavernous fistula carotidcavernous fistulas are a specific type of abnormal connection of the arteries directly into the venous system. There are a number of causes, however, aneurysm rupture and trauma are by far the most common. 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 definition of carotid. This article is from march 2008 and may contain outdated material. Traumatic carotidcavernous fistula tccf arises from head injury and results in a direct shunt between the internal carotid artery ica and the cavernous sinus, which usually occurs in young men. Diagnosis and management of carotid cavernous fistulas. Endovascular treatment of direct carotid cavernous. 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. Craniofacial trauma is a major factor for this complication.
These may manifest with signs and symptoms referable to cervical myelopathy secondary to. Imaging diagnosis of dural and direct cavernous carotid. A carotid cavernous fistula is an abnormal communication between a carotid artery and the cavernous sinus. Features fullscreen sharing embed analytics article stories visual stories seo. Traumatic carotid cavernous fistula accompanying basilar skull fracture. Ccf represents an abnormal communication from the carotid artery to the cavernous sinus. Despite the similarity of symptoms between both types, a precise diagnosis is essential since. Over the years, numerous classifications have been applied to ccfs. Venous drainage patterns in carotid cavernous fistulas. Endovascular treatment of these lesions is challenging. Description an arteriovenous fistula is a disruption of the normal blood flow pattern. Neurosurgery, which involves occlusion of the carotid artery both above and below the site of the fistula, may be required. Introduction carotid cavernous fistula ccf is the abnormal communication between the internal carotid artery and the cavernous sinus.
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. Ccf is an abnormal communication between carotid arterial system internal carotid artery ica or external carotid artery eca and cavernous sinus cs fig. The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. A carotidcavernous sinus fistula ccf is an abnormal connection between an artery in your neck and the network of veins at the back of your eye. When an abnormal connection happens between either of the carotid arteries and the veins just behind the eye, it is called a carotid. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Ruptured cavernous sinus aneurysms causing carotid. Carotidcavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus.
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. Epileptic seizures induced by a spontaneous carotid cavernous fistula. This frontal view shows the enlarged left carotidcavernous sinus fistula right compared to the normal right cavernous sinus left. The carotidcavernous fistula ccf is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach.
Carotid cavernous fistula ccf is the abnormal communication between the internal carotid artery and the cavernous sinus. Four cases in which the diagnosis of carotidcavernous fistula was made by using ct angiography are illustrated. Early diagnosis of this rare vascular complication can preserve vision. Injections of the right and left carotid arteries demonstrate a fistula at the posterior aspect of the left cavernous sinus medial compartment pink, supplied by various branches of the left and right mht. Sep, 2006 direct carotidcavernous fistulae ccfs are type a fistulae according to barrows classification.