Learning objectives
This poster aims to strictly review direct carotid-cavernous fistulas (dCCF), their imaging features and a brief description of its treatment options; presenting several cases from our institution.
Background
Carotid cavernous fistulas (CCF) are a subtype of dural arteriovenous fistulas that consist of an abnormal communication between the cavernous sinus and the carotid artery. This communication may be classified either as direct if the defect is on the wall of the internal carotid artery (ICA) or as indirect if the defect is on meningeal branches of the ICA or external carotid artery.
There are other classifications based on the pathogenesis (traumatic or spontaneous), on the flow dynamics of the fistula (high or low flow)...
Findings and procedure details
IMAGING FINDINGS
Cross-sectional imaging such as MRI and CT can be useful as initial diagnostic procedures, especially when employing intravenous contrast and angiographic techniques. Indirect signs that may clue the underlying pathology are [11,12]:
Cavernous sinus asymmetry,
Early enhancement of the sinus (Fig. 7),
Dilated or thrombosed ophthalmic veins,
Extraocular muscle thickening,
Proptosis (Fig. 8),
Periocular soft tissues oedema,
Skull fractures (Fig. 9),
Flow void indicating high flow within the sinus (T2-weighted and SWI sequences of MRI) (Fig. 10),
Intracranial haemorrhage (complication).
However, there are...
Conclusion
Direct carotid-cavernous fistulasare life-threateningand have serious comorbidity.
Most frequent cause:trauma.
There is a shunt between a high flow arterial system and a low flow venous one.
Symptoms depend on the venous reflux pattern andcranial nerves compression.
There are usefulCT, MRI and US findings.
Gold standard for diagnosis: four-vessel DSA.
Endovascular treatmentisoptedfor most cases.
Personal information and conflict of interest
J. M. Vieito Fuentes; Vigo/ES - nothing to disclose A. Rojas; Vigo/ES - nothing to disclose Á. J. de la Iglesia; Vigo/ES - nothing to disclose
References
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Mancall EL, Brock DG, Gray H, editors. Gray’s clinical neuroanatomy: the anatomic basis for clinical neuroscience. Philadelphia, PA: Elsevier Saunders; 2011. 433p.
Fattahi TT, Brandt MT, Jenkins WS, Steinberg B. Traumatic carotid-cavernous fistula: pathophysiology and treatment. J Craniofac Surg. 2003 Mar;14(2):240–6.
Ringer AJ, Salud L, Tomsick TA. Carotid cavernous fistulas: anatomy, classification, and treatment. Neurosurg Clin N Am. 2005 Apr;16(2):279–295, viii.
Gonzalez Castro LN, Colorado RA, Botelho AA,...