No abstract available.
Carotid-Cavernous Sinus Fistula*

Carotid-cavernous fistula (CCF) is a rare and dangerous neurological disorder that arises due to an abnormal communication between the internal carotid artery (ICA) or the external carotid artery (ECA) and their branches and the cavernous sinus. It can either be a direct fistula (high-flow with acute symptoms) most commonly resulting from trauma (70-90%) or an indirect fistula (low-flow with insidious symptoms) secondary to hypertension, atherosclerosis and collagen vascular disorders. The shunting of arterial blood into the venous system leads to venous hypertension causing various clinical manifestations depending on the venous drainage patterns and the shunt flow. Increased anterior, posterior and superior venous drainage results to orbital/ocular, cavernous and cortical symptomatology, respectively. This paper aims to present a case of 58-year old Filipino female with a 2-day history of sudden, severe headache, vomiting and blurring of vision followed by decrease in sensorium and sudden proptosis and chemosis of the left eye. Patient had no co-morbidities, history of trauma, surgeries, facial skin infections or prior febrile illness. The left eye had exophthalmos, subconjunctival hyperemia, scleral edema/chemosis and ocular bruit. Neurologic examination showed a stuporous patient with multiple cranial nerve deficits (impaired direct and consensual pupillary reflex left, complete ptosis left, sluggish corneal reflex left, impaired oculocephalic reflex left), right hemiplegia and meningeal signs. Cranial Computed Tomography (CT) Angiogram revealed an acute parenchymal hemorrhage in the left frontotemporal lobe with subarachnoid component, with engorged left cavernous sinus and dilated left superior ophthalmic vein. Digital Subtraction Angiography (DSA) was done revealing a direct type of left carotid-cavernous fistula with massive ICA shunting to the cavernous sinus, superior ophthalmic vein and inferior petrosal sinus. The clinical and radiographic evidence were consistent with a Direct/Type A CCF. Unique in this case was a patient with no history of trauma presenting with simultaneous orbital/ocular, cavernous and cortical symptomatology – a clinical picture of CCF that has never been documented in any literature nor included in any classification system. The presence of all three symptomatology can be explained by a direct/highflow fistula that resulted to increased anterior, posterior and superior venous drainage as documented in the DSA. In addition, spontaneous intracranial hemorrhage in CCF is exceptionally rare and it is the most daunting symptomatology of this disease. With that, this specific case may pave the way to a new classification scheme and determine its corresponding treatment approach.
Carotid-Cavernous Sinus Fistula ; Cavernous Sinus

No abstract available.
Carotid-Cavernous Sinus Fistula* ; Facial Bones* ; Humans

No abstract available.
Carotid-Cavernous Sinus Fistula ; Facial Bones

Carotid cavernous sinus fistula is abnormal communication between the carotid artery and the cavernous sinus. It can be classified according to three criteria : 1) pathologically into spontaneous or traumatic ; 2) hemodynamically into high flow or low flow fistula ; 3) angiographically into direct or dural fistula. We studied the regional cerebral blood flow changes in traumatic carotid cavernous sinus fistula. Regional cerebral blood flow checked 7 times during trapping procedure. The results are as follows ; 1) regional cerebral blood flow decreased in normal side than in lesion side hemisphere in the state of carotid cavernous fistula. 2) After compression of lesion side common carotid artery over 10 minutes, cerebral blood flow increased in both side. 3) Cerebral blood flow decreased temporary after operation on both side but normalized 2 or 3 weeks later.
Carotid Arteries ; Carotid Artery, Common ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Fistula*

Dural carotid-cavernous sinus fistula is an abnormal communication between meningeal branches of the carotid artery and cavernous sinus. It usually occurs spontaneously, and 25 to 50% of fistula close spontaneously. Most cases are unilateral and rarely, contralateral or bilateral symptoms occur. Most of the patients are postmenopausal women, and show dilated conjunctival and episcleral vessels, exophthalmos, limited ocular movement and elevation of intraocular pressure. We report a case of dural carotid-cavernous sinus fistula in a 53 year old woman with typical ophthalmic manifestations.
Carotid Arteries ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Exophthalmos ; Female ; Fistula ; Humans ; Intraocular Pressure ; Middle Aged

Most trauma induced fistulas are direct communications between the intracavernous carotid artery and the cavernous sinus. Theses abnormal communications are characterized by high pressure, high blood flow and a clinically obvious constellation of symptoms and signs. We here in report a patient with traumatic carotid cavernous sinus fistula(CCSF). who developed central retinal vein occlusion(CRVO) during detachable balloon embolization. The mechanism of CRVO occurring during detachable balloon embolization. The mechanism of CRVO occurring during detachable ballon embolization for CCSF was discussed. We report this case with the review of previous reports.
Balloon Occlusion ; Carotid Arteries ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Fistula ; Humans ; Retinal Vein*

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.
Carotid Artery, External ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Fistula ; Follow-Up Studies

Presenting symptoms of carotid cavernous fistulas (CCF) may vary according to the draining vessels. Prominent external orbito-ocular signs such as red eye, proptosis, ocular bruit occur, when the shunt drains anteriorly ("red-eyed shunts"), whereas an isolated ocular motor nerve palsy and headache can be the only presenting symptoms when it drains posteriorly ("white-eyed shunts"). Turning the eyes red from white eyed-shunt weeks to months ("delayed red-eyed shunts") suggest the direction of fistula drainage shifted anteriorly; it has rarely been reported. We report a patient with delayed red-eyed shunts whose red eye resolved after chemical embolization of draining vessels.
Carotid-Cavernous Sinus Fistula ; Drainage ; Exophthalmos ; Fistula* ; Headache ; Humans ; Paralysis

Transvenous coil embolization has been successfully applied for the treatment of cavernous sinus dural arteriovenous fistula (CSDAVF). Unfortunately, the technique cannot be applied in cases of poor or absent inferior petrosal sinus or facial venous access route to the fistula. Recently, we experienced a successful embolization using direct superior ophthalmic vein approach in cases of CSDAVF which were no opacification of inferior petrosal sinus or facial vein.
Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Endovascular Procedures ; Fistula ; Veins