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1.
BMJ Case Rep ; 14(5)2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34045204

RESUMO

A 36-year-old man presented with proptosis and external ophthalmoplegia of the left globe following road traffic injury. Cerebral angiogram revealed moderate flow direct carotid cavernous fistula on left side for which coil embolisation was done repeatedly. Subsequently, the patient developed decreased vision in left eye and developed features of left-sided ocular ischaemic syndrome. The patient was treated conservatively with spontaneous reversal of ocular ischaemic syndrome and complete regain of visual function.


Assuntos
Fístula Carotidocavernosa , Embolização Terapêutica , Oftalmopatias , Doenças Vasculares , Adulto , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/terapia , Embolização Terapêutica/efeitos adversos , Olho , Humanos , Masculino
2.
J Clin Neurosci ; 86: 230-234, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775333

RESUMO

BACKGROUND: Direct carotid cavernous fistula (CCF) occurs between the internal carotid artery (ICA) and the cavernous sinus. Carotid cavernous fistulas (CCFs) frequently present with chemosis, pulsatile proptosis, ocular bruit, vision loss, and occasionally intracerebral hemorrhage or seizure. In this article, we share our experience in endovascular treatment of six patients having this pathology with intracranial flow diverting stents with review of literatures. CASE DESCRIPTION: All six patients had posttraumatic direct CCF, most of their signs and symptoms were visual disturbance, chemosis, orbital bruit, headache, paralysis of extraocular muscles. They were treated with flow diversion stents with or without coils or liquid embolizing material; transvenous and transarterial routes were used. Most of them underwent multiple sessions, and their conditions were improved dramatically. CONCLUSION: The best and most effective method is to start the procedure by coiling to convert the high-flow fistula to an aneurysmal pouch with the smallest possible size in the cavernous sinus, and then close the defect site with one or two flow diversion devices (FDDs).


Assuntos
Fístula Carotidocavernosa/terapia , Traumatismos Craniocerebrais/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Stents Metálicos Autoexpansíveis , Adulto , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Resultado do Tratamento , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/etiologia , Transtornos da Visão/terapia , Adulto Jovem
3.
BMJ Case Rep ; 14(3)2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33753387

RESUMO

Carotid-cavernous fistulas (CCFs) are abnormal connections between arteries and the cavernous sinuses. Traditionally, the Barrow Classification system has been used to characterise these fistulas based on their arterial supply from the internal carotid artery (ICA), external carotid artery (ECA) or both. We present a unique case of a patient with a complex CCF with arterial feeders from dural branches of the ECA, ICA and vertebral artery (VA), which, to our knowledge, has not been reported in the literature. Given unique arterial supply pattern involving contribution from the extracranial VA, this CCF falls outside of the traditional Barrow Classification system. The patient ultimately underwent a transfemoral transvenous coil embolisation using multiple dynamic venous routes with obliteration of bilateral CCFs and near complete resolution of her preoperative symptoms.


Assuntos
Fístula Carotidocavernosa , Seio Cavernoso , Embolização Terapêutica , Prótese Vascular , Artéria Carótida Externa , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Feminino , Humanos
5.
Artigo em Russo | MEDLINE | ID: mdl-32649819

RESUMO

Successful treatment of direct spontaneous carotid-cavernous fistula in a 9-month-old child and review of the literature devoted to this issue are reported in the manuscript. Spontaneous high-flow carotid-cavernous fistula is extremely rare in children. Detailed diagnosis of the fistulae includes CT-angiography and cerebral subtraction angiography. Previous surgeries (nasolacrimal canal repair in this case) may be considered as an etiological factor of carotid-cavernous fistula. Transarterial transfemoral endovascular embolization of the fistula with microcoils ensured closure of abnormal communication and complete regression of clinical manifestations in our case.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/cirurgia , Embolização Terapêutica , Ducto Nasolacrimal , Angiografia Cerebral , Criança , Humanos , Lactente , Procedimentos Cirúrgicos Vasculares
6.
J Craniofac Surg ; 31(5): 1412-1417, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32398616

RESUMO

BACKGROUND: The A type of carotid-cavernous fistulas (CCF-A) is characterized by direct communication between the internal carotid artery (ICA) with a very low incidence. But it severely endangers the health and even the life of patients, not only causes insufferable symptoms but also can induce fatal epistaxis, intracranial hemorrhages or even death. So, this disease needs therapy as early as possible. The ideal treatment for CCF-A is to exclude the fistula from circulation, preserving the carotid flow. Interventional therapy has become the chief method for CCF-A especially in recent years, but the prerequisite, that the microwire or and microcatheter in ICA can be navigated across the orificium fistulae and into distal ICA, is necessary. Otherwise it is difficult to reserve the communication of seriously injured ICA and the orificium fistulae could simultaneously be reliably closed. The authors used a series of new and novel CCF with good result. METHODS: The authors experienced a patient of TCCF-A, whose ICA was seriously injured and customary method failed in the first treatment because the microwire and microcatheter could not cross the segment of orificium fistulae. Then, the authors applied military (outflanking techniques, aerial refueling, and retrograde navigation) to manage this case. RESULTS: Finally, the CCF-A was completely cured and the parent artery was perfect preserved without any complication. CONCLUSIONS: For patients of TCCF-A with severe ICA injury, these strategies may be very important for some patients whose affected ICA cannot tolerant to be blocked.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Adolescente , Angiografia , Artéria Carótida Interna , Fístula Carotidocavernosa/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X
8.
World Neurosurg ; 137: 338-340, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035205

RESUMO

BACKGROUND: Cavernous-carotid fistulas (CCFs) can present with a variety of symptoms depending on the anatomy of the fistula and its venous drainage. Patients most commonly present with scleral injection, pulsatile exophthalmos, and/or chemosis. CASE DESCRIPTION: We report a patient who presented with intraparenchymal hemorrhage in the absence of any of the commonly associated ocular symptoms and signs. After multiple imaging studies, the CCF was diagnosed and treated with endovascular embolization that resulted in complete occlusion of the fistula and reflux of embolysate into one of its connecting veins. CONCLUSIONS: The morphology of the venous drainage can lead to atypical hemorrhagic presentation, whereas dilatation of one of the tributary veins with cortical venous reflux should warn the interventionist the path the embolysate may follow. We provide our experience with this unique presentation and its treatment.


Assuntos
Fístula Carotidocavernosa/complicações , Hemorragia Cerebral/etiologia , Adulto , Angiografia Digital , Artérias Carótidas/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/fisiopatologia , Fístula Carotidocavernosa/terapia , Seio Cavernoso/diagnóstico por imagem , Angiografia Cerebral , Hemorragia Cerebral/fisiopatologia , Diplopia , Síndrome de Down/complicações , Embolização Terapêutica , Epilepsia/complicações , Exoftalmia , Olho/irrigação sanguínea , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Transtornos da Visão
10.
J Neurol Surg A Cent Eur Neurosurg ; 81(3): 243-252, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32045943

RESUMO

OBJECTIVE: To describe unique indications for covered stent grafts in trauma-associated cerebrovascular injuries. PATIENTS: Between 2006 and 2018, five patients with cerebrovascular injuries were treated with a covered stent graft. We present a retrospective analysis of technique and outcomes. RESULTS: In all cases stent deployment was successful. Endoleaks occurred in two cases requiring additional transvenous embolization of a carotid cavernous fistula (CCF) in one patient. Two cases of in-stent thrombosis were observed during intervention and 2 days postintervention in a patient with a long-segment dissection of the internal carotid artery (ICA) and another patient with a contained ICA rupture, both of which could not be prepared with dual antiplatelet therapy. Intravenous heparin and intra-arterial tirofiban dissolved in-stent thrombosis efficiently. One CCF and an iatrogenic vertebral artery injury were covered adequately with GraftMaster stent grafts. CONCLUSION: Patient selection with regard to individual anatomy and the site of vascular lesions is essential for an uncomplicated deployment of covered stent grafts and the success of therapy. Management of dual antiplatelet therapy, anticoagulation, and an escalation of medication in cases of in-stent thrombosis require expertise, a strict therapeutic regime, and an evaluation of individual risks in polytraumatized patients.


Assuntos
Implante de Prótese Vascular , Dissecação da Artéria Carótida Interna/cirurgia , Fístula Carotidocavernosa/cirurgia , Seleção de Pacientes , Stents , Dissecação da Artéria Vertebral/cirurgia , Idoso , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/etiologia , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/etiologia
11.
World Neurosurg ; 134: 221-227, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31712112

RESUMO

BACKGROUND: Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery. METHODS: The aim of this article is to report a case of CCF after the endoscopic resection of a growth hormone secreting pituitary microadenoma, and to discuss and review all the cases of CCF secondary to transsphenoidal procedures described in literature. RESULTS: A patient aged 74 years was operated for a growth hormone pituitary microadenoma through an endoscopic transsphenoidal surgery. During the procedure, a copious bleeding from the left cavernous sinus was managed with hemostatic material. A direct CCF was diagnosed and managed with transvenous and transarterial coiling. A complete exclusion of the fistula was possible, and the patency of the internal carotid artery was maintained. A total of 9 other cases have been reported. A transsphenoidal approach was performed for sellar tumors in 6 cases, and for chronic sinusitis in 2 cases. In 7 cases, intraoperative hemorrhage was reported, which could be controlled in 5 cases. The postoperative diagnosis of CCF was immediate in 5 cases. Patients presented with persistent bleeding after nasal unpacking or later with chemosis and proptosis. Cerebral angiography was the gold standard for the diagnosis. Eight cases were successfully treated through endovascular techniques with no recurrence observed at follow-up (mean of 15 months). No major neurologic complications were observed. CONCLUSIONS: CCF should be suspected with every abnormal bleeding after transsphenoidal surgeries, even when the symptoms are mild. Diagnostic arteriography and endovascular treatment represent the mainstay of the management, and an early diagnosis strongly improves the prognosis.


Assuntos
Adenoma/cirurgia , Fístula Carotidocavernosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Neuroendoscopia , Complicações Pós-Operatórias/terapia , Adenoma/patologia , Idoso , Angiografia Digital , Fístula Carotidocavernosa/diagnóstico por imagem , Angiografia Cerebral , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Humanos , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide
12.
J Neurointerv Surg ; 12(3): e3, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31818968

RESUMO

Direct carotid cavernous fistulae (CCF) are often detected early and treated promptly resulting in a paucity of literature regarding its long-term evolution. We present a case of high flow post-traumatic direct CCF that was neglected for over 6 years and presented with a rare manifestation of primary intraventricular haemorrhage. Occlusions of the primary venous outlets likely resulted in engorgement of the deep venous system. The segmental anatomy of the shunting basal vein is critical to the clinical presentation and may range from basal ganglia or brainstem oedema/infarctions to uniquely, as in our case, isolated intraventricular haemorrhage secondary to variceal rupture. Treatment in such chronic cases requires a consideration of cerebral hyperperfusion syndrome necessitating deconstructive techniques with subsequent anticoagulation to avoid accelerated thrombosis of the venous varices.


Assuntos
Fístula Carotidocavernosa/cirurgia , Angiografia Cerebral/métodos , Hemorragia Cerebral/cirurgia , Ventrículos Cerebrais/cirurgia , Procedimentos Endovasculares/métodos , Varizes/cirurgia , Adulto , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/cirurgia , Ventrículos Cerebrais/diagnóstico por imagem , Embolização Terapêutica/métodos , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Varizes/complicações , Varizes/diagnóstico por imagem
13.
World Neurosurg ; 134: 211-214, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678447

RESUMO

BACKGROUND: Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Surgical treatment can be challenging, and for most cases an endovascular approach is the treatment of choice. CASE DESCRIPTION: We present an unusual case of a direct CCF with an associated large traumatic aneurysm in the sphenoid sinus due to a history of trauma presenting with unusual symptoms that was treated by a combined endoscopic and endovascular approach. CONCLUSIONS: Concurrent occurrence of a traumatic CCF and traumatic aneurysm of the cavernous segment is extremely rare. Early diagnosis and treatment of these lesions are important considering their high mortality rate. Complete occlusion of the fistula and aneurysm while preserving the patency of the carotid artery via an endovascular approach is the treatment of choice for these lesions.


Assuntos
Artéria Carótida Interna/cirurgia , Fístula Carotidocavernosa/cirurgia , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Neuroendoscopia/métodos , Seio Esfenoidal , Adulto , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Epistaxe/etiologia , Exoftalmia/etiologia , Traumatismos Cranianos Fechados/complicações , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Masculino , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
14.
Acta Radiol ; 61(7): 945-952, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31698923

RESUMO

BACKGROUND: Carotid-cavernous fistulas (CCFs) are commonly misdiagnosed on computed tomography angiography (CTA). PURPOSE: This study sought to identify the most sensitive and specific imaging features of CCFs on CTA. MATERIAL AND METHODS: A retrospective review identified 18 consecutive patients suspected of having a CCF on CTA and subsequently underwent digital subtraction angiography (DSA). Two blinded reviewers assessed multiple findings on CTA: cavernous sinus asymmetry/enlargement; arterial-phase contrast in the cavernous sinus; proptosis; pre- or post-septal orbital edema; and dilated regional vasculature. Each was graded as positive, possible, and negative; "possible" was counted as positive. A third blinded reviewer served as a tiebreaker. RESULTS: Of 18 patients, nine were true-positive and nine were false-positive. Superior ophthalmic vein early enhancement and dilatation had 100.0% sensitivity (95% confidence interval [CI] 40.0-100.0) and 77.8% specificity (95% CI 44.4-100.0); arterial-phase contrast in the cavernous sinus had 88.9% sensitivity (95% CI 44.4-100.0) and 66.7% specificity (95% CI 18.5-90.1); peri-orbital edema had 88.9% sensitivity (95% CI 35.5-100.0) and 77.8% specificity (95% CI 22.2-100.0). The most specific markers of CCF were superior petrosal sinus and inferior ophthalmic vein dilatation/enhancement (100.0%, 95% CI 88.8-100.0 and 88.9%, 95% CI 44.4-100.0, respectively); the specificity of asymmetric cavernous enlargement was 44.4% (95% CI 11.1-77.7). CONCLUSIONS: Among patients in whom a CCF is suspected on CTA, superior ophthalmic vein dilatation/enhancement and arterial-phase contrast within the cavernous sinus are the most sensitive findings. Asymmetric cavernous sinus enlargement has poor specificity and may result in false-positive diagnoses of CCFs. False positive cases were less likely to have an optimally timed contrast bolus.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Erros de Diagnóstico/prevenção & controle , Adulto , Angiografia Digital , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
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
16.
BMJ Case Rep ; 12(11)2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31712243

RESUMO

A 59-year-old man presented with a 2-week history of binocular horizontal diplopia worse when looking to the left. He was diagnosed with a left sixth nerve palsy (6 NP) and had new bilateral findings at a 2-week follow-up with new dilated episcleral blood vessels. Bilateral carotid-cavernous fistulas (CCFs) were suspected and confirmed with CT angiography and catheter angiography. He underwent successful coil and Onyx embolisation of the left cavernous sinus and immediately noticed worsening of the double vision when looking left due to a worse left 6 NP. Three weeks later, he underwent similar treatment of the right CCF and immediately noticed worsening of the double vision when looking to the right and was found to have a worse right 6 NP. His double vision resolved 6 months later. CCFs are rare causes of bilateral 6 NPs and although there is a good prognosis, symptoms may worsen after treatment.


Assuntos
Doenças do Nervo Abducente/etiologia , Fístula Carotidocavernosa/complicações , Embolização Terapêutica/métodos , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Resultado do Tratamento , Transtornos da Visão/etiologia
17.
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
18.
AJNR Am J Neuroradiol ; 40(9): 1498-1504, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395664

RESUMO

BACKGROUND AND PURPOSE: 4D CT angiography is increasingly used in clinical practice for the assessment of different neurovascular disorders. Optimized processing of 4D-CTA is crucial for diagnostic interpretation because of the large amount of data that is generated. A color-mapping method for 4D-CTA is presented for improved and enhanced visualization of the cerebral vasculature hemodynamics. This method was applied to detect cranial AVFs. MATERIALS AND METHODS: All patients who underwent both 4D-CTA and DSA in our hospital from 2011 to 2018 for the clinical suspicion of a cranial AVF or carotid cavernous fistula were retrospectively collected. Temporal information in the cerebral vasculature was visualized using a patient-specific color scale. All color-maps were evaluated by 3 observers for the presence or absence of an AVF or carotid cavernous fistula. The presence or absence of cortical venous reflux was evaluated as a secondary outcome measure. RESULTS: In total, 31 patients were included, 21 patients with and 10 without an AVF. Arterialization of venous structures in AVFs was accurately visualized using color-mapping. There was high sensitivity (86%-100%) and moderate-to-high specificity (70%-100%) for the detection of AVFs on color-mapping 4D-CTA, even without the availability of dynamic subtraction rendering. The diagnostic performance of the 3 observers in the detection of cortical venous reflux was variable (sensitivity, 43%-88%; specificity, 60%-80%). CONCLUSIONS: Arterialization of venous structures can be visualized using color-mapping of 4D-CTA and proves to be accurate for the detection of cranial AVFs. This finding makes color-mapping a promising visualization technique for assessing temporal hemodynamics in 4D-CTA.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Tomografia Computadorizada Quadridimensional/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Idoso , Angiografia Digital/métodos , Fístula Carotidocavernosa/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
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
20.
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
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