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1.
World Neurosurg ; 133: e479-e486, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541756

RESUMO

BACKGROUND: Cavernous carotid fistulas (CCF) are anatomically complex vascular lesions. Treatment via the venous approach has been previously described and is highly dependent on the patency of the drainage pathways. The use of a unilateral approach to contralateral or bilateral shunts is technically challenging and not commonly described. We present our experience with the unilateral across-the-midline approach to both cavernous sinuses to treat shunts according to anatomic compartments to achieve anatomic cure. METHODS: Patients included in this study presented with either bilateral or unilateral shunts with unilateral venous drainage. We used a transarterial guiding catheter for road mapping and control angiography. A venous triaxial system was used to achieve support for distal navigation across the midline via the coronary sinus to the contralateral cavernous sinus. Coils were favored for embolization, with occasional complementary liquid embolic material. RESULTS: Five patients underwent complete occlusion in a single session. One patient required additional complementary transarterial embolization. Despite a successful unilateral approach to bilateral cavernous sinuses, 1 patient needed an additional ipsilateral transophthalmic venous approach to obliterate the anterior compartment of the cavernous sinus. No complications were encountered. Complete angiographic cure was observed in all patients by the end of the final procedures, with persistent occlusion in their follow-up imaging. CONCLUSIONS: Careful inspection of the venous anatomy and fistulization sites is critical when treating unilateral or bilateral carotid cavernous shunts. The contralateral venous route can serve as a safe approach when visualized. Crossing the midline via the anterior or posterior coronary sinuses is feasible and efficacious.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Cateterismo , Seio Cavernoso , Angiografia Cerebral , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Veias
2.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527207

RESUMO

A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Subsequent imaging revealed an indirect (type D) carotid-cavernous fistula (CCF) with venous drainage into both SOVs and cavernous sinuses. Successful treatment of the CCF with coil embolisation required interdisciplinary teamwork between ophthalmologists and interventional neuroradiologists. The patient made a substantial visual recovery following treatment.


Assuntos
Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/terapia , Oftalmopatias/etiologia , Oftalmopatias/terapia , Hipertensão/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Embolização Terapêutica , Olho/irrigação sanguínea , Olho/diagnóstico por imagem , Oftalmopatias/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
3.
J Stroke Cerebrovasc Dis ; 28(11): 104306, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31439523

RESUMO

Carotid-Cavernous sinus fistula (CCF) caused by a ruptured aneurysm of persistent primitive trigeminal artery (PPTA) is exceptionally rare. Herein, we reported the case of a 64-year-old female who presented with headache, pulsatile tinnitus, and diplopia. Angiography showed a PPTA and CCF. Three-dimensional digital subtraction angiograms revealed a direct shunt between the PPTA aneurysm and the left cavernous sinus. The trigeminal carotid fistula was successfully treated with detachable coils and Onyx, and the PPTA was preserved. Hence, coil and Onyx occlusion of the cavernous sinus is a safe and effective treatment for trigeminal carotid fistula.


Assuntos
Aneurisma Roto/etiologia , Artéria Basilar/anormalidades , Artéria Carótida Interna/anormalidades , Fístula Carotidocavernosa/etiologia , Malformações Vasculares do Sistema Nervoso Central/complicações , Aneurisma Intracraniano/etiologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Artéria Basilar/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Combinação de Medicamentos , Embolização Terapêutica/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Pessoa de Meia-Idade , Polivinil/administração & dosagem , Tantálio/administração & dosagem , Resultado do Tratamento
4.
Arch. Soc. Esp. Oftalmol ; 94(8): 400-404, ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185627

RESUMO

Mujer de 73 años que acude a consulta con diagnóstico de hipertiroidismo de 8 meses de evolución. Desde entonces comenzó con hiperemia y proptosis ocular. En la exploración se observa exoftalmos bilateral de predominio derecho, ligera hiperemia conjuntival en ojo derecho asociada a vasos epiesclerales aumentados en su calibre con forma de cabeza de medusa. Tomografía computada con recto inferior aumentado de calibre sin datos de compresión de nervio óptico. En el estudio doppler de órbita se encuentra un flujo arteriorizado sobre la vena oftálmica superior con un posible diagnóstico de fístula carótido-cavernosa. La orbitopatía tiroidea relacionada a una fístula carótido-cavernosa es una asociación infrecuente, ya que los datos clínicos de una de las patologías pueden enmascarar a la otra, por lo que es importante el conocimiento de ambas enfermedades para su correcto diagnóstico y tratamiento multidisciplinario


The case concerns a 73 year-old female with a diagnosis of hyperthyroidism of 8 months onset. Since then, she has suffered hyperaemia and ocular proptosis. Bilateral exophthalmos was observed in the physical examination, along with mild conjunctival hyperaemia in the right eye associated with dilated episcleral vessels. Computed tomography showed enlarged inferior rectus with no signs of ocular nerve or ophthalmic superior vein compression. In the orbital Doppler ultrasound scan, there was an arterialised flow over the superior ophthalmic vein, giving a possible diagnosis of cavernous carotid. Thyroid orbitopathy with a cavernous carotid fistula is an unusual combination in which the clinical signs of both pathologies can mask the complete diagnosis; thus it is important to be acquainted with both pathologies for their correct management and multidisciplinary treatment


Assuntos
Humanos , Feminino , Idoso , Fístula Carotidocavernosa/complicações , Oftalmopatia de Graves/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Olho/irrigação sanguínea , Oftalmopatia de Graves/diagnóstico , Hiperemia/diagnóstico , Hipertireoidismo/complicações , Músculos Oculomotores/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Veias/diagnóstico por imagem
6.
J Neurointerv Surg ; 11(11): 1129-1134, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31266856

RESUMO

BACKGROUND: Direct carotid-cavernous sinus fistulas (dCCFs) are high flow arteriovenous shunts between the internal carotid artery and the cavernous sinus. Recently, we have used the pipeline embolization device (PED) to treat dCCFs. METHODS: We describe our experience treating patients with dCCFs in whom the PED was placed as the primary treatment modality. RESULTS: Five patients with dCCFs were treated with PEDs deployed in the ipsilateral internal carotid artery spanning the fistula. All patients also underwent either adjunctive transvenous or transarterial embolization. The PED served both as the primary treatment modality and as a scaffold that facilitated safe and efficacious transvenous embolysate administration by altering the flow dynamics through the fistula and providing a physical barrier that protected the internal carotid artery. No intraoperative or perioperative complications occurred. One of the five patients exhibited complete angiographic resolution of the fistula immediately after the procedure. The remaining four patients experienced complete obliteration of the fistula without additional treatment, which suggests that the PED induced alteration promoted thrombosis of the fistula. Therefore, 100% of patients in this series exhibited complete and durable obliteration of the fistula and complete resolution of symptoms following treatment. CONCLUSIONS: We believe that use of the PED to treat dCCFs may be a safe and efficacious strategy that facilitates parent vessel protection during transvenous embolization. Furthermore, the flow alterations induced by the PED may promote thrombosis of incompletely occluded fistulas. This is the largest reported series of non-iatrogenic dCCFs treated with use of the PED as the primary initial treatment strategy.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Adolescente , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Arch Soc Esp Oftalmol ; 94(8): 400-404, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31176495

RESUMO

The case concerns a 73 year-old female with a diagnosis of hyperthyroidism of 8 months onset. Since then, she has suffered hyperaemia and ocular proptosis. Bilateral exophthalmos was observed in the physical examination, along with mild conjunctival hyperaemia in the right eye associated with dilated episcleral vessels. Computed tomography showed enlarged inferior rectus with no signs of ocular nerve or ophthalmic superior vein compression. In the orbital Doppler ultrasound scan, there was an arterialised flow over the superior ophthalmic vein, giving a possible diagnosis of cavernous carotid. Thyroid orbitopathy with a cavernous carotid fistula is an unusual combination in which the clinical signs of both pathologies can mask the complete diagnosis; thus it is important to be acquainted with both pathologies for their correct management and multidisciplinary treatment.


Assuntos
Fístula Carotidocavernosa/complicações , Oftalmopatia de Graves/complicações , Idoso , Fístula Carotidocavernosa/diagnóstico por imagem , Olho/irrigação sanguínea , Feminino , Oftalmopatia de Graves/diagnóstico , Humanos , Hiperemia/diagnóstico , Hipertireoidismo/complicações , Músculos Oculomotores/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Veias/diagnóstico por imagem
8.
World Neurosurg ; 128: e621-e631, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075494

RESUMO

BACKGROUND: Multiple carotid cavernous fistula (CCF) classifications have been proposed. However, they lacked predictive factors for the clinical presentation, natural history, and hemorrhagic risk. Our aim was to externally validate a new classification according to venous drainage (i.e., the Thomas classification [TC]) to assess its relationship with symptoms, endovascular treatment, and outcomes. METHODS: We performed a multicenter retrospective review of CCFs at 2 major academic institutions. The CCFs were classified using the Barrow classification (BC) and TC systems. RESULTS: The data from 94 patients with a diagnosis of CCF were collected during a study period 23 years, 4 months. Of these 94 patients, 89 had undergone CCF treatment and 5 had experienced spontaneous occlusion. Complete occlusion was achieved in 89.9% of the treated patients. Complications occurred in 5.3% of the patients, including permanent deficits in 2.1%. TC type 4 was associated with cortical symptoms compared with type 2 (P = 0.003) and type 3 (P < 0.001). The BC was not able to detect significant differences among the symptom types. Significant differences were found using the TC for the transarterial-only, transvenous anterior-only, and transvenous posterior-only approaches (P < 0.001, P = 0.03, and P = 0.001, respectively). The transvenous posterior and transvenous anterior approach were significantly associated with type 2 and 3 TC, respectively. Excluding direct CCFs, the BC was not related to the treatment approach. No significant differences in the outcomes were found. However, a trend toward a lower occlusion rate for TC type 4 compared with type 3 was observed. CONCLUSION: The TC provided useful information regarding the fistula anatomy and venous hemodynamics, which correlated with the clinical symptoms and treatment strategy.


Assuntos
Fístula Carotidocavernosa/classificação , Seio Cavernoso/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/classificação , Idoso , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/fisiopatologia , Fístula Carotidocavernosa/terapia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Angiografia Cerebral , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
World Neurosurg ; 128: 360-364, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31128309

RESUMO

BACKGROUND: Persistent primitive trigeminal artery (PPTA) is the most common type of fetal carotid-basilar persisting communication in adulthood; however, carotid-cavernous fistulas (CCFs) associated with PPTA are rare. CASE DESCRIPTION: An 84-year-old woman presented with traumatic CCF associated with PPTA manifesting as vascular bruit. Transarterial embolization was performed. Although a detachable coil was deployed at the fistula point, it was easy to migrate into the cavernous sinus because of the high-flow shunt. Therefore, a stent was deployed in the PPTA, and the inner lumen of the stent with a focus on the fistula point was occluded by using coils. Subsequently, the CCF completely disappeared. CONCLUSIONS: In-stent coil embolization was effective and reasonable for the high-flow CCF associated with the PPTA. This method reduced the number of coils required and operating time. However, careful preservation of perforators is needed.


Assuntos
Fístula Carotidocavernosa/cirurgia , Artérias Cerebrais/cirurgia , Embolização Terapêutica/métodos , Stents , Idoso de 80 Anos ou mais , Angiografia Digital , Fístula Carotidocavernosa/diagnóstico por imagem , Artérias Cerebrais/anormalidades , Feminino , Humanos , Ruptura/cirurgia , Tomografia Computadorizada por Raios X , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia
10.
Medicine (Baltimore) ; 98(11): e14732, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882640

RESUMO

This study aims to explore the principles of clinical classification and individualized treatment of basicranial artery injuries based on its anatomical correlation.The data of 172 patients with various types of basicranial artery injuries were retrospectively analyzed. Among these patients, 128 patients were male and 44 patients were female, and the average age of these patients was 28.3 years old. All patients underwent computed tomography, some patients underwent computed tomography angiography or magnetic resonance angiography, and all the diagnoses were confirmed by digital subtraction angiography (DSA). According to anatomical correlation, the injuries were classified into 5 types: vascular wall injury (type I), intradural injury (type II), epidural injury (type III), sinus injury (type IV), and skull base bone injury (type V). Individualized treatment was adopted based on the different types and characteristics of injuries.The percentages of basicranial artery injuries were as follows: type I, 4.6%; type II, 5.8%; type III, 3.5%; type IV, 77.9%; and type V, 8.1%. All 172 patients underwent DSA to demonstrate the classification. The lesion elimination rate revealed by DSA was 99.4% immediately after the operation, 98.3% at 1 week after the operation, and 98.8% at 3 months after the operation. The follow-up after 6 months revealed that the percentage of patients in whom clinical symptoms or signs completely disappeared was 97.7%, the percentage of patients with limited eye movement or visual impairment was 1.2%, and the percentage of patients with mild limb dysfunction was 0.6%.Basicranial artery injuries can be classified into 5 types. Individualized design of embolization therapy based on different characteristics might be applicable for basicranial artery injuries treatment.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto , Fístula Carotidocavernosa/etiologia , Angiografia por Tomografia Computadorizada , Traumatismos Craniocerebrais/complicações , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Lesões do Sistema Vascular/classificação
11.
World Neurosurg ; 127: 216-219, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30910749

RESUMO

BACKGROUND: Cranial dural arteriovenous fistulas (dAVFs) are abnormal connections between arteries supplying the dura mater and the cranial venous system. These present with various signs and symptoms. Progressive ocular manifestations are quite rare and may be confused with carotid cavernous fistulas (CCF). CASE DESCRIPTION: Here, we present 2 cases of dAVF manifesting with ocular symptomatology referred to our center erroneously diagnosed as CCF, and discuss the effect of venous drainage pattern on the clinical presentation. CONCLUSIONS: Ocular manifestations of cerebrovascular origin are not necessarily associated with CCF or cavernous sinus dAVF. Other vascular malformations such as dAVFs should be considered specifically when accompanied by venous stenosis distal to the site of the fistula.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Olho/patologia , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/cirurgia , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Cavidades Cranianas/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
12.
BMJ Case Rep ; 12(2)2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30782625

RESUMO

We report the first case of a post-traumatic direct carotid cavernous fistula (CCF) treated with the XCalibur aneurysm occlusion device, which is a balloon mounted stent with flow diversion effect. Two devices were deployed across the fistula in an overlapping manner, resulting in complete occlusion of the fistula. Flow diversion with this device can provide a safe and alternative treatment option in direct CCF.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Embolização Terapêutica/instrumentação , Exoftalmia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Acidentes de Trânsito , Aspirina/uso terapêutico , Fístula Carotidocavernosa/patologia , Angiografia Cerebral , Clopidogrel/uso terapêutico , Embolização Terapêutica/métodos , Exoftalmia/patologia , Dor Ocular/diagnóstico por imagem , Dor Ocular/patologia , Humanos , Masculino , Neuroimagem , Inibidores da Agregação de Plaquetas/uso terapêutico , Stents , Resultado do Tratamento , Adulto Jovem
13.
J Neurointerv Surg ; 11(9): 937-939, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30777891

RESUMO

INTRODUCTION: Indirect cavernous carotid fistulae (ICCFs) can present with insidious, non-specific symptoms and prove difficult to diagnose. This study evaluates associations among ICCF symptoms and angiographic findings. METHODS: A retrospective analysis was performed of prospectively maintained records at four medical centers to identify patients with ICCFs evaluated with angiography. Patient demographics, symptoms, and angiographic findings were tabulated. Univariate and multivariate analyses were conducted to identify associations among these variables. RESULTS: Records sufficient for review existed for 267 patients evaluated with angiography. Patients were most commonly women, in the sixth or seventh decade of life, and had symptoms for months before a definitive diagnosis. The most common symptoms included proptosis, diplopia, cranial nerve palsy, and chemosis. Cortical venous reflux was most common in patients with chemosis, orbital pain, or bruit. Intracranial hemorrhage was associated with cortical reflux and bilateral inferior petrosal sinus occlusion. Patients with loss of symptoms demonstrated higher rates of inferior petrosal sinus occlusion and a trend towards rupture. CONCLUSION: A high index of suspicion is needed to promptly diagnose patients with ICCFs. High risk features are more common in the setting of chemosis, orbital pain, bruit, or spontaneous loss of symptoms. Patients with such symptoms warrant expedited angiographic evaluation.


Assuntos
Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Angiografia Cerebral/métodos , Adulto , Idoso , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Doenças dos Nervos Cranianos/diagnóstico por imagem , Doenças dos Nervos Cranianos/etiologia , Diplopia/diagnóstico por imagem , Diplopia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
15.
Interv Neuroradiol ; 25(1): 71-89, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30244626

RESUMO

Spontaneous regression of direct carotid-cavernous fistulas (CCFs) is extremely rare. Most of the patients with direct CCFs are usually treated using endovascular techniques. Spontaneous obliteration of the direct fistulas probably results from thrombosis of the venous drainage and/or cavernous sinus. We report spontaneous closure of nine direct CCFs in nine patients. From literature review, we found another 37 patients with 43 fistulas due to spontaneous obliteration of bilateral lesions in six cases. There was no spontaneous closure in large-sized fistula. The factors associated with spontaneous thrombosis of the fistulas may be low-flow and small-sized fistula, hypotension, severe ocular manifestations, dissections or spasm of carotid artery, and increased intracranial pressure. Spontaneous healing of direct traumatic CCFs should be confirmed with cerebral angiography. Conservative treatment of direct CCFs should be carefully restricted in patients with normal vision or minimal visual impairment, and the patients must be monitored closely for any changes in visual function. Prompt endovascular treatment for complete obliteration of the fistula should be performed in patients with rapidly progressive visual loss. Venous thrombosis can still effect vision and rerouting towards cortical veins remains a concern. Because spontaneous resolution cannot be reliably predicted, the fistula then should be treated rather than waiting for spontaneous thrombosis.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Remissão Espontânea , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Idoso , Angiografia Cerebral , Traumatismos Craniocerebrais/complicações , Feminino , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
16.
Interv Neuroradiol ; 25(2): 135-138, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30380952

RESUMO

Direct carotid-cavernous fistulas (CCFs) are high flow lesions that can be challenging to treat. A number of recent reports suggest that flow diversion may be a viable treatment option. We present a case of a post-traumatic CCF successfully treated with flow diversion and provide a review of the literature. Our results suggest that flow diversion is a potentially effective treatment option for CCFs and is most successful when used as an adjunctive therapy.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica/instrumentação , Acidentes por Quedas , Angiografia Digital , Anticoagulantes/uso terapêutico , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Dimetil Sulfóxido/uso terapêutico , Escala de Coma de Glasgow , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Masculino , Polivinil/uso terapêutico , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Am J Emerg Med ; 37(2): 378.e7-378.e9, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30415985

RESUMO

A ruptured cavernous carotid aneurysm (CCA) with carotid cavernous fistula can appear as a benign headache but progress to a swollen and bloodshot eye overnight. A 66-year-old woman visited emergency department with sudden onset of pain behind her left forehead and vomiting. She was treated for a migraine-like headache and discharged. She presented again on the next day with a persistent headache and a swollen left eye with blurred vision. An ophthalmologic examination revealed erythema of the left lid and chemosis at the temporal and lower bulbar conjunctiva. A cranial nonenhanced computed tomography (CT) scan had been performed at her previous visit. The scan exhibited a nodular mass lesion involving the left cavernous sinus. CT angiography was subsequently used to determine that the lesion was a giant aneurysm in the left cavernous internal carotid artery, causing enlargement of the left ophthalmic veins. The symptoms of her left eye rapidly progressed to severe chemosis, edematous change over periocular region, and limited movements after 8 h. The patient received emergent lateral canthotomy and inferior cantholysis to avoid acute orbital compartment syndrome and was subsequently treated with stent-assisted coil embolization. A ruptured CCA is an urgent condition that requires rapid assessment of both cranial vascular and ocular lesions. A history of sudden onset headache with a nonpainful acute unilateral red eye may serve as a clue to prompt additional diagnostic studies and ophthalmologist evaluation. Adequate radiological studies and early endovascular intervention can reduce the likelihood of permanent ocular injury and vision impairment.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Edema/etiologia , Eritema/etiologia , Cefaleia/etiologia , Baixa Visão/etiologia , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/terapia , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Serviço Hospitalar de Emergência , Feminino , Humanos , Aparelho Lacrimal/cirurgia
18.
World Neurosurg ; 122: 123-128, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391766

RESUMO

BACKGROUND: Vascular Ehlers-Danlos syndrome (vEDS) is a vascular disease associated with a genetic collagen abnormality. It is characterized by vessel fragility, vessel rupture, and massive hemorrhage. Carotid-cavernous fistula (CCF) is the most frequent neurovascular complication of vEDS. However, CCF treatment using conventional diagnostic angiography and neuroendovascular therapy can result in a high rate of major complications. CASE DESCRIPTION: We report a case of a right CCF in a 48-year-old man with vEDS. The carotid artery and jugular vein were exposed by direct neck dissection. To avoid systemic vascular complications, multiple catheters were inserted into the shunt segment via the carotid artery and jugular vein. This transarterial and transvenous multidevice technique enabled compact placement of coils in the shunt segment. The CCF was eliminated via selective shunt occlusion. Postoperative magnetic resonance imaging revealed occlusion of the right CCF. CONCLUSIONS: Selective shunt occlusion via a transarterial and transvenous multidevice technique is a useful and safe approach for treating vEDS-associated CCF.


Assuntos
Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/cirurgia , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/cirurgia , Procedimentos Endovasculares , Fístula Carotidocavernosa/diagnóstico por imagem , Síndrome de Ehlers-Danlos/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade
19.
Interv Neuroradiol ; 25(1): 66-70, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30165774

RESUMO

INTRODUCTION: Multiple ways to access the dural carotid cavernous fistula have been described. The aim of the present study was to assess the results of embolization of a dural carotid cavernous fistula via different routes using endovascular accesses as a first-line strategy. METHODS: A retrospective data analysis of a consecutive series of 63 patients presenting with dural carotid cavernous fistula was performed. RESULTS: The dural carotid cavernous fistula was accessed by an endovascular approach in 58 patients (92.1%) and by direct puncture in five patients (7.9%). The inferior petrosal sinus was the main route accessed (65%). A recanalization of an occluded inferior petrosal sinus was obtained in 20.6% of cases. The access via either facial ophthalmic veins or the superior petrosal sinus was obtained in 20.6% and 3.1% of cases, respectively. Complete angiographic occlusion of a dural carotid cavernous fistula immediately after treatment was achieved in 53 patients (84.1%), whereas 10 patients (15.9%) displayed a partial occlusion. Treatment-related complications were observed in two patients (3.2%). CONCLUSIONS: In this study, the endovascular approach allowed dural carotid cavernous fistula embolization in most patients. The inferior petrosal sinus, even when thrombosed, was the main route used to access the dural carotid cavernous fistula, followed by the facial vein, direct cavernous sinus puncture, and the superior petrosal sinus.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Angiografia Cerebral , Dura-Máter , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Resultado do Tratamento
20.
Orbit ; 38(4): 290-299, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30465621

RESUMO

Purpose: The main objective was to report the epidemiology, clinical manifestations, angiography features, treatment modality and post-treatment outcomes in patients diagnosed with carotid cavernous fistulas (CCF). Methods: A retrospective review of the medical imaging database in conjunction with medical records from 2004 to 2017 at the Royal Brisbane and Women's Hospital (RBWH) was conducted.We identified 39 patients with CCF (16 direct, 23 indirect). A total of 37 diagnoses were confirmed by direct catheter angiography. The remaining two cases were diagnosed using magnetic resonance imaging/magnetic resonance angiography. Results: Coils were deployed in 100% of direct and 83% of treated indirect fistulas that were treated. Other embolic agents were deployed alone or in combination with coils. Successful angiographic closure was achieved in 93% of direct and 92% of indirect fistulas. Multiple treatments were required in 33% of direct and 16% of indirect fistulas. Visual acuity improved in patients with direct fistulae(p = 0.02) and was preserved in those with indirect fistulae. Post-treatment diplopia persisted in six patients with direct fistulas and three patients with indirect fistulas. Four patients with indirect fistulas experienced persistent ocular hypertension post-treatment compared to two patients with direct fistulas. Conclusions: Endovascular coils are the most commonly deployed treatment for CCF. Both indirect and direct fistulas achieved high rates of closure; however, indirect fistulas were less likely to require multiple treatments. Good post-procedural vision was achieved for both groups.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares , Acuidade Visual/fisiologia , Angiografia Digital , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/epidemiologia , Fístula Carotidocavernosa/fisiopatologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
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