The Clinical Characteristics and Treatment Outcomes of Dural Carotid-Cavernous Sinus Fistula.
- Author:
Cheol KIM
1
;
Sang In KHWARG
;
Moon Hee HAN
Author Information
1. Department of Ophthalmology, Seoul National University College of Medicine, Korea. khwarg@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Arteriovenous;
Carotid;
Cavernous;
Dural;
Embolization;
Fistula
- MeSH:
Age of Onset;
Carotid-Cavernous Sinus Fistula*;
Cerebral Angiography;
Diabetes Mellitus;
Diagnosis;
Dilatation;
Drainage;
Exophthalmos;
Female;
Fistula;
Follow-Up Studies;
Glaucoma, Neovascular;
Humans;
Hyperemia;
Hypertension;
Intraocular Pressure;
Orbit;
Paralysis;
Retinal Vein;
Retrospective Studies;
Veins
- From:Journal of the Korean Ophthalmological Society
2003;44(7):1463-1474
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To report the clinical characteristics and treatment outcomes of dural carotid-cavernous sinus fistula (CCF). METHODS: Fifteen cases of dural CCF confirmed with cerebral angiography were retrospectively analyzed. RESULTS: The mean age of onset was 57.2 years. The cases had 12 female patients and 2 bilateral cases. There were 3 diabetes mellitus, 2 hypertension patients and 3 patients with history of trauma. The most common chief complaints were conjunctival injection and exophthalmos. Elevated intraocular pressure (IOP) and corkscrew vessel were the most common ophthalmic findings. On orbital CT, 13 cases other than 2 cases showed dilatation of superior ophthalmic vein. On cerebral angiography, there were 10 Barrow Type D cases, in which the superior ophthalmic vein was the main drainage. Eleven patients were treated with embolization 2.0 (1-5) times per patient on the average. During the follow-up period, 5 cases were complicated with central retinal vein occlusion (CRVO). At the last follow-up, all cases except 1 neovascular glaucoma showed normalized IOP but 1 case had conjunctival injection, 3 had residual exophthalmos, and 1 had cerebral nerve palsy. CONCLUSIONS: The diagnosis of dural CCF should be suspected at a middle-aged woman with conjunctival hyperemia or exophthalmos, and the clinician should be careful about the IOP and CRVO. The embolization, though the success rate of 1 first treatment is not so high, is thought to be the best treatment modality because it is less invasive and it brings the improvement of clinical symptom nearly in all cases.
