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2.
Cesk Slov Oftalmol ; 1(Ahead of print): 1-8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33086846

RESUMO

Carotid-cavernous fistula (CCF) is an abnormal communication - vascular connection between arteries and veins in the cavernous sinus. Classification according to etiology is traumatic vs spontaneous. According to blood flow rate per high flow vs low flow fistula. According to anatomy of direct vs indirect: Direct (direct) CCF arises through direct communication between the internal carotid artery (ICA) and the cavernous sinus. Indirect CCF originates through indirect communication through the meningeal branches of ICA, external carotid artery and cavernous sinus (not directly with ICA) and Barrow type A, B, C, D division. Patients subjective complaints depend on the type of CCF. Most often it is pulsating tinnitus, synchronous with blood pulse. Typical findings include protrusion and pulsation of the eyeball, corkscrew vessels - arterialization of conjunctival and episleral vessels, increased intraocular pressure, not responding to local antiglaucomatous therapy, keratopathy a lagophthalmo, corneal ulcers. In the later untreated stages of CCF, secondary, venous stasis or central retinal vein occlusion can occur. Diagnostic procedures include B-scan and color Doppler ultrasonography, digital ophthamodynamometry, computer tomography, nuclear magnetic resonance and digital subtraction angiography. CCF can simulate orbitopathy, conjunctivitis symptoms, carotid occlusion, scleritis or cavernous sinus thrombosis. The ophthalmologist should recognize and indicate the necessary examinations in a timely manner. The therapy is ophthalmological, neuroradiological, sterotactic, surgical and conservative.


Assuntos
Fístula Carotidocavernosa , Seio Cavernoso , Fístula , Oftalmologistas , Fístula Carotidocavernosa/diagnóstico , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/terapia , Humanos , Imagem por Ressonância Magnética
3.
J Vis Exp ; (159)2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32510491

RESUMO

Carotid cavernous fistula (CCF) is a rare disease caused by abnormal communications between the internal carotid artery (direct fistula) or meningeal branches of the external carotid artery (indirect fistula) and the cavernous sinus (CS). Trauma is the most common cause of CCF. The clinical presentation of CCF is closely related to the venous drainage pattern. Orbital and neuro-ophthalmological symptoms are the most common clinical presentation of CCF with drainage through the superior ophthalmic vein (SOV). Endovascular embolization by arterial or venous approaches is the most common management of CCF. Transvenous embolization using detachable coils and ethylene-vinyl alcohol copolymer (EVOH) is an alternative method for the treatment of CCF. Endovascular embolization offers different options to treat CCF by minimally invasive approach decreasing morbidity and residual fistulas. The purpose of this article is to report our treatment experiences via the inferior petrosal sinus (IPS), and immediate-term outcomes of endovascular embolization of CCF by using detachable coils and EVOH.


Assuntos
Fístula Carotidocavernosa/terapia , Seio Cavernoso/efeitos dos fármacos , Embolização Terapêutica/métodos , Polivinil/farmacologia , Fístula Carotidocavernosa/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
World Neurosurg ; 140: 18-25, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32437988

RESUMO

BACKGROUND: Carotid-cavernous fistulas (CCFs) are abnormal communications between the arterial and venous circulation within the cavernous sinus, manifesting in myriad neurological and ophthalmological sequalae. In rare circumstances patients' unique vascular anatomies preclude standard endovascular treatment for this pathology, warranting combined surgical and endovascular approaches wherein the cavernous sinus is accessed via superior ophthalmic vein (SOV) exposure, cutdown, and cannulation. CASE DESCRIPTION: We describe 3 cases of CCF treated at our quaternary neurovascular referral center between 2017 and 2019. The first is a 35-year-old man with symptomatic, traumatic, right-sided CCF, treated with endovascular therapy (transarterial detachable balloon placement). The other cases were treated with contrasting surgical and endovascular combined approaches because of unique vascular challenges. The second is a 71-year-old woman with spontaneous right-sided CCF whose carotid sinus was accessed and embolized through a transpalpebral cutdown of the SOV. The third case is a 70-year-old man with symptomatic, spontaneous bilateral CCF. After unsuccessful transarterial and transvenous endovascular approaches, transorbital (intracranial) SOV cutdown and cannulation were performed to embolize the shunting fistula. CONCLUSIONS: Endovascular approaches are well described as the mainstay of treatment for CCF but are not possible for all patients. In circumstances where individual vascular anatomy is not amenable to transarterial or transvenous access or embolization, a combined surgical and endovascular approach may be appropriate. We describe 3 cases that illustrate the spectrum of interventions for CCF, as well as the technical aspects of treatment for 2 patients with complex, direct CCF, using an embolization approach reliant on SOV cutdown and cannulation.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Feminino , Humanos , Masculino
7.
J Clin Neurosci ; 78: 389-392, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32331942

RESUMO

A carotid-cavernous fistula (CCF) is an abnormal connection between the carotid circulation and the cavernous sinus. Treatment of CCFs often consists of obliteration of the fistula by a transarterial or transvenous endovascular approach using embolic agents. However, fistula embolization is often halted due to the potential embolic complications that may arise from the retrograde flow of the embolic agents into the arterial circulation, which often leads to the development of fistula recurrence. Moreover, retreatment of a CCF recurrence is challenging and more complex approaches may be required. In this technical note, we describe our experience with CCF embolization in 25 patients treated at a single center. We utilized a transvenous approach for CCF embolization with simultaneous balloon occlusion of the internal carotid artery during the infusion of the embolic material into the fistula. In our series, this simultaneous protection of the internal carotid artery showed to be a safe technique to prevent embolic complications and to achieve successful obliteration of the fistula. On follow-up, 2 cases presented a recurrence, one due to technical difficulties and the other related to an undetected vascular injury. In conclusion, this technique provides a safe approach in the treatment of CCFs by decreasing the risk of embolic complications and increasing the effectiveness of the embolic agents in accomplishing the obliteration of the CCF.


Assuntos
Oclusão com Balão/métodos , Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Artéria Carótida Interna , Seio Cavernoso , Embolização Terapêutica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
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 , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Transtornos da Visão
10.
World Neurosurg ; 133: 409-412, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31421298

RESUMO

BACKGROUND: Carotid cavernous aneurysm (CCA) rupture is rare. However, it can result in various complications such as carotid cavernous fistula (CCF), epistaxis, spontaneous thrombosis, and subarachnoid hemorrhage. CASE DESCRIPTION: We report a 65-year-old woman with a history of uncontrolled diabetes who was referred with complaints of acute headache, diplopia, proptosis, and chemosis. Ophthalmic examination revealed elevated intraocular pressure in the right eye, optic disk edema, and retinal venous congestion. Canthotomy was performed based on a diagnosis of orbital compartment syndrome (OCS). Further imaging revealed a dilated superior ophthalmic vein and cavernous sinus, as well as swelling of the extraocular muscles in the right eye. Digital subtraction angiography revealed the fistulous connection between the cavernous part of the internal carotid and cavernous sinus (direct CCF) due to the large ruptured CCA, resulting in retrograde flow through the superior and inferior ophthalmic veins. Successful endovascular coiling of the aneurysm resulted in complete occlusion of the fistula. Postintervention ophthalmic examination demonstrated progressive improvement of ophthalmic signs and symptoms; however, the patient's right eye remained sightless. CONCLUSIONS: In patients with clinical manifestation of OCS with no history of any predisposing risk factors, diagnosis of ruptured cavernous sinus aneurysm and resulting direct CCF should be considered. In such cases, emergent imaging along with early endovascular intervention can resolve OCS and prevent permanent ocular injury and vision loss.


Assuntos
Aneurisma Roto/complicações , Fístula Carotidocavernosa/complicações , Síndromes Compartimentais/etiologia , Oftalmopatias/etiologia , Idoso , Aneurisma Roto/terapia , Fístula Carotidocavernosa/terapia , Síndromes Compartimentais/terapia , Procedimentos Endovasculares , Oftalmopatias/terapia , Feminino , Humanos , Resultado do Tratamento
11.
World Neurosurg ; 133: e796-e803, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605852

RESUMO

BACKGROUND: Techniques for endovascular management of carotid-cavernous fistulas (CCFs) have evolved over the years. Current strategies include transarterial or transvenous approaches and direct puncture or exposure of the cavernous sinus. Rarely, complex CCFs may require multiple approaches or procedures. We describe our experience managing CCFs, reporting on outcomes and technical nuances. METHODS: A retrospective review of institutional records was conducted to identify consecutive cases of CCF treated between July 2005 and July 2016. Pertinent technical details and outcomes were recorded. RESULTS: In 44 patients, 51 procedures were performed. There were 13 direct CCFs and 31 indirect CCFs: 13 (30%) type A, 3 (7%) type B, 5 (11%) type C, and 23 (52%) type D. A transarterial approach was selected in 39% of cases (n = 20), resulting in a long-term successful embolization rate of 60% (n = 12). Transvenous methods via the inferior petrosal sinus or superior ophthalmic vein were used in 49% of cases (n = 25), resulting in a long-term obliteration rate of 88% (n = 22). Multimodal management was required in 5 patients, including 1 patient in whom a craniotomy was performed to facilitate coil embolization of the cavernous sinus under direct vision. A 7% complication rate (n = 3) was observed, with significant morbidity in 1 patient. CONCLUSIONS: CCFs are complex vascular lesions that require facility with various endovascular and surgical approaches. High-flow, direct-type fistulas may harbor a significant risk of recurrence after transarterial embolization. Partial or unsuccessful embolization may necessitate an open surgical approach to the superior ophthalmic vein or cavernous sinus.


Assuntos
Fístula Carotidocavernosa/terapia , Seio Cavernoso/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
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 , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide
13.
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
14.
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
15.
Medicine (Baltimore) ; 98(48): e18184, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770272

RESUMO

RATIONALE: Dual aneurysms arising from the internal cerotic artery (ICA) is a very rare occurrence. Clinoid segment aneurysms (CSAs) are often seen at the carotid dural rings while cavernous carotid aneurysms (CCAs) are often a direct communication between the ICA and the cavernous sinus (CS). We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) PATIENT CONCERNS:: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Neurological examinations were unremarkable. DIAGNOSIS: Magnetic resonance imaging (MRI) and computer tomography (CT)-scan revealed dual aneurysms on the ICA. Digital subtracting angiogram (DSA) confirmed a small CSA and a large CCA on the right ICA. INTERVENTIONS: We treated both aneurysms with PLED and subsequently observed DAR of CCA as a complication. OUTCOMES: We successfully occluded the fistula with ONYX (ev3, Irvine, CA) via the trans-venous approach. LESIONS: PLED was the best endovascular treatment option though DAR was inevitable. Although the trans-arterial approach may be the gold standard for the managing of CCF, the complex nature of our case made us opt for trans-venous approach. The trans-venous route is very appropriate for fistulas with complex parent arteries.


Assuntos
Aneurisma Roto , Aneurisma , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa , Seio Cavernoso/diagnóstico por imagem , Embolização Terapêutica/métodos , Aneurisma/complicações , Aneurisma/diagnóstico , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Aneurisma Roto/terapia , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/fisiopatologia , Fístula Carotidocavernosa/terapia , Angiografia Cerebral/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
J Glaucoma ; 28(12): 1074-1078, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31658226

RESUMO

PRECIS: Secondary ocular hypertension (OHT) is common in carotid-cavernous fistulas (CCFs). Management of elevated intraocular pressure (IOP) is possible with a multidisciplinary approach. The ipsilateral normal eyes may have higher IOP than the contralateral eyes. PURPOSE: To study the IOP profile of the eyes of patients with a CCF, treatment outcomes for elevated IOP, and intereye IOP asymmetry in the eyes with normal IOP. METHODS: This was a retrospective case series. A total of 64 eyes of 60 patients with digital subtraction angiography-proven CCF diagnosed from the year 2000 to 2016 were included. The demographics, clinical features, management, and outcomes were recorded. The primary outcome included understanding of the cause of elevated IOP. The secondary outcomes included comparison of the IOP between contralateral eyes and ipsilateral normal eyes (IOP <21 mm Hg) and management outcomes for elevated IOP. RESULTS: The mean age of the patients was 45.6±18.2 years. In the study population, 70% of the patients were males. Indirect CCF was present in 55% of the eyes. It was found that 64.06% (n=41) of the eyes had elevated IOP, glaucoma, or were glaucoma suspects. Among all the eyes, 40.62% (n=26) of the eyes had secondary OHT due to elevated episcleral venous pressure, whereas 7.81% (n=5) of the eyes had secondary open-angle glaucoma. The mean IOP was higher in the ipsilateral eyes than in the other eyes (22.95±7.1vs. 15.11±2.99 mm Hg; P<0.001). The mean IOP in the ipsilateral normal eyes was higher than that in the contralateral eyes, with a mean difference of 2.92±2.29 mm Hg (confidence interval of the mean difference: 1.90-3.94 mm Hg; P<0.0001). IOP reduction (<21 mm Hg) was achieved in 70.7% of the patients following CCF management with intermittent carotid massage, endovascular treatment, IOP-lowering medications, or a combination among these. CONCLUSIONS: Secondary OHT due to elevated episcleral venous pressure was more common than secondary open-angle glaucoma. Ipsilateral normal eyes had higher IOP than contralateral eyes. IOP-lowering agents and management of CCF resulted in IOP control in most patients.


Assuntos
Fístula Carotidocavernosa/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Fístula Carotidocavernosa/diagnóstico , Fístula Carotidocavernosa/terapia , Criança , Pré-Escolar , Embolização Terapêutica , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/fisiopatologia , Estudos Retrospectivos , Tonometria Ocular , Resultado do Tratamento
17.
PLoS One ; 14(10): e0223488, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622360

RESUMO

PURPOSE: Endovascular embolization nowadays is a well-established treatment option for direct carotid cavernous fistulas (dCCF, Barrow Type A). There are many publications on the complication and success rates of this method. However, little is known on the patients´ opinion on the treatment result after several years. We report on this issue also including the "pioneer patients" treated almost two decades ago. METHODS: We retrospectively reviewed the records of all patient (n = 25) with a more than 24 months follow-up interval after endovascular treatment of a dCCF at our institution from 01/1999 to 08/2018. We determined primary therapy success, complication rate, state of the fistula in the last imaging follow-up and quoted the patient's subjective perception of the long-term treatment success using a standardized interview form. RESULTS: Occlusion rate in the last imaging follow up was 96% (24/25) with a complication rate of 8% (2/25). The response rate on our interview request was 96% (24/25) with a rate of considered feedback of 84% (21/25 patients). Duration of our observation interval for the patient reported outcome was 143 months / 11 years (median, range: 35-226 m / 2-18 y). Most of them (21/25, 84%) felt they benefited from the treatment. CONCLUSIONS: Endovascular supply of dCCF is a highly effective treatment method leading to a sustainable therapy success with long-lasting stable subjective benefit even to our "pioneer patients" treated almost two decades ago.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Adulto , Idoso , Fístula Carotidocavernosa/diagnóstico , Fístula Carotidocavernosa/etiologia , Angiografia Cerebral/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Estudos Retrospectivos , Adulto Jovem
18.
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
19.
Tunis Med ; 97(1): 145-148, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31535707

RESUMO

PURPOSE: to report a case of a woman who had a severe cranial trauma complicated by two ophalmologic potentially cecitating complications: right carotido-cavernous fistula and left traumatic optic neuropathy. OBSERVATION: A 56 years-old woman, without any medical history, referred, one month after fall from a height of 3 meters, for right exophthalmos. Ophthalmic examination of the right eye completed by retinal angiography suspected carotid-cavernous fistula which was confirmed by angio-MRI. In the left eye, the visual acuity was decreased to no light perception and fundus examination showed optic nerve head palor secondary to traumatic optic neuropathy. Arterial embolization was performed and allowed closing of the fistula. CONCLUSION: Optic neuropathy and carotido-cavernous fistula are two severe complications that can occur simultaneously in the same patient. The prognosis of the optic neuropathy may be compromised, and the treatment of carotido-cavernous fistula benefited from progress in interventional neuro-radiology.


Assuntos
Fístula Carotidocavernosa/etiologia , Traumatismos Craniocerebrais/complicações , Doenças do Nervo Óptico/etiologia , Fístula Carotidocavernosa/diagnóstico , Fístula Carotidocavernosa/terapia , Seio Cavernoso/patologia , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/terapia , Embolização Terapêutica , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Exoftalmia/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/terapia , Resultado do Tratamento
20.
World Neurosurg ; 131: 196, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31421303

RESUMO

Carotid-cavernous fistulas are vascular malformations that pose a risk for intracranial hemorrhage when there is documented cortical venous drainage. When possible, treatment with transvenous embolization has become the technique of choice since the late 1990s.1,2 We present a case of a patient with a carotid-cavernous fistula treated with venous coil embolization via a jugular venous approach. The patient was a 59-year-old female with a history of intense headaches. Initial magnetic resonance imaging showed congestion in the right cavernous sinus, and a diagnostic angiogram revealed a cavernous carotid fistula Thomas type 4.3,4 Given the presence of retrograde cortical venous drainage, we decided to treat the lesion. A femoral route for endovascular treatment was attempted, but it was unsuccessful in traversing the external jugular vein due to venous valves. We accessed the fistula through a direct puncture direct proximal approach,5 from the external jugular vein making our trajectory through the facial-angular-supraorbital vein, ultimately reaching the cavernous sinus. We then filled the sinus with coils to obliterate the fistula. The patient awakened neurologically intact, and a postoperative angiogram demonstrated complete occlusion of the lesion. The patient was discharged at postoperative day 1 without complications. In this video, we narrate the important details of this alternative when a traditional route is inaccessible (Video 1). Informed consent was obtained for the case illustrated; however, neither Institutional Review Board nor patient consent is required for the report of a single case in which no identifiable patient information is shared.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Veias
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