DURAL CAROTID-CAVERNOUS FISTULAS
Background. Dural carotid-cavernous sinus fistulas (CCF) are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI) or/and external carotid artery (ACE). In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.
Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«). Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«). Also different therapeutic approaches as well as possible complications are described.
Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.
Acierno MD, Trobe JD, Cornblath WT, Gebarski SS. Painful oculomotor palsy caused by posterior-draining dural carotid-cavernous fistulas. Arch Ophthalmol 1995; 113: 1045–9.
Talks SJ, Salmon JF, Elston JS, Bron AJ. Cavernous-dural fistula with secondary angle-closure. Am J Ophthalmol 1997; 124: 851–3.
Fiore PM, Latina MA, Shingleton BJ, Rizzo JF, Ebert E, Bellows AR. The dural shunt syndrome. I. Management of glaucoma. Ophthalmology 1990; 97: 56–62.
Phelps CD, Thompson HS, Ossoinig KC. The diagnosis and prognosis of atypical carotid-cavernous fistula (red-eyed shunt syndrome). Am J Ophthalmol 1982; 93: 423–36.
Costa VP, Molnar LJ. Diagnosing and monitoring carotid cavernous fistulas with color Doppler imaging. J Clin Ultrasound 1997; 25: 448–52.
Kuppersmith MJ, Berenstein A, Choi IS, Warren F, Flamm E. Management of nontraumatic vascular shunts involving the cavernous sinus. Ophthalmology 1988; 95: 121–30.
Gupta N, Kikkawa DO, Levi L, Weinreb RN. Severe vision loss and neovascular glaucoma complicating superior ophthalmic vein approach to carotid-cavernous sinus fistula. Am J Ophthalmol 1997; 124: 853–5.
Komiyama M, Yamanaka, Nagata Y, Ishikawa H. Dural carotid-cavernous sinus fistula and central retinal vein occlusion. Surg Neurol 1990; 34: 255–9.
Knosp E, Mueller G, Perneczky A. The blood supply of the cranial nerves in the lateral wall in the cavernous sinus. In: Dolenc VV ed. The cavernous sinus. A multidisciplinary approach to vascular and tumorous lesions. WienNew York: Springer Verlag , 1987: 67–80.
Sasaki H, Nukui H, Kaneko M, Mitsuka S et al. Long-term observation in cases with spontaneous carotid-cavernous fistulas. Acta Neurochir 1988; 90: 117–20.
Halbach VV, Higashida RT, Hieshima GB, Reicher M, Norman D, Newton TH. Dural fistulas involving the cavernous sinus: Results of treatment in 30 patients. Radiology 1987; 163: 437–42.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.