Carotid-cavernous fistula

Zimmerman R, Leeds NE, Naidich TP (1977) Carotid-cavernous fistula associated with intracranial fibromuscular dysplasia. Radiology 122 725-726... 

Thrombosis of the cavernous sinus is characterized by proptosis, chemosis, impaired vision and ophthalmoplegia. If it is not septic, prognosis is good because of collateral drainage and spontaneous recanalization. The same symptoms, with the exception of a possible bruit, may result from arteriovenous shunting in carotid-cavernous fistulae. The treatment of choice in this case is endovascular occlusion (thrombosis ) of the cavernous sinus. 

Schlenun s canal may be seen if blood refluxes into the canal. This might indicate elevated episcleral venous pressure caused by conditions such as a carotid-cavernous fistula, Graves orbitopathy, or Sturge-Weber syndrome. 

Speakman TJ (1964) Internal occlusion of a carotid-cavernous fistula. J Neurosurg 21303-305... 

Kawaguchi T, Kawano T, Kaneko Y et al (1999a) Dural arteriovenous fistula of the transverse sigmoid sinus after transvenous embolization of the carotid cavernous fistula. No To Shinkei 51 1065-1069... 

Kerber CW, Bank WO, Cromwell LD (1979) Cyanoacrylate occlusion of carotid-cavernous fistula with preservation of carotid artery flow. Neurosurgery 4 210-215... 

Kubota Y, Ueda T, Kaku Y et al (1999) Development of a dural arteriovenous fistula around the jugular valve after transvenous embolization of cavernous dural arteriovenous fistula. Surg Neurol 51 174-176 Kurata A, Miyasaka Y, Oka H et al (1999) Spontaneous carotid cavernous fistulas with special reference to the influence of estradiol decrease. Neurol Res 21 631-639 Labbe D, Courtheoux P, Rigot-Jolivet M et al (1987) Bilateral dural carotid-cavernous fistula. Its treatment by way of the superior ophthalmic vein. Rev Stomatol Chir Maxil-lofac 88 120-124... 

Among vascular diseases that may chnicaUy appear as tumor-like lesions, there are capillary and cavernous hemangioma, orbital vein anomaly, venous-lymphatic malformation, orbital vein thrombosis, and carotid-cavernous fistula. When large, vascular lesions oftentimes are not confined to one orbital space alone, and they may extend to extra-orbital locations of the head and neck (Flis and Connor 2005). 

Fig. 40.11. Traumatic direct carotid cavernous fistula in DSA. Cross-sectional imaging of 3D FD-CT data accurately depicts the fistulous arterio-venous vessel wall defect. The 3D fusion image demonstrates the contralateral superficial venous drain-...

Debrun G, Lacour P, Vinuela F, et al. (1981) Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 55 678-692... 

Meder JF, Devaux B, Merland JJ et al (1995) Spontaneous disappearance of a spinal dural arteriovenous fistula. AJNR Am J Neuroradiol 16 2058-2062 Miki T, Nagai K, Saitoh Y et al (1988) Matas procedure in the treatment of spontaneous carotid cavernous sinus fistula a complication of retinal hemorrhage. No Shinkei Geka 16 971-976... 

Miller NR, Monsein LH, Debrun GM et al (1995) Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg 83 838-842 Mironov A (1998) Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR Am J Neuroradiol 19 389-391... 

In the transvenous approach for treatment of direct carotid-cavernous sinus fistulae, unintentional coil prolapse in the supplying artery is a feared compfication, which may result in emboHc stroke. Due to dramatically reduced reconstruction times down to less than 1 min, FD-CT can be quickly performed and thus might be very helpful in the assessment of coil protrusions in the parent artery, otherwise not visible in 2D projections (Fig. 40.11). 

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