DURAL CAROTID-CAVERNOUS FISTULAS

  • Barbara Cvenkel Očesna klinika Klinični center Zaloška 29 1525 Ljubljana
  • Vinko V. Dolenc Klinični oddelek za nevrokirurgijo Klinični center Zaloška 7 1525 Ljubljana
  • Zoran Miloševič Klinični inštitut za radiologijo Klinični center Zaloška 7 1525 Ljubljana
Keywords: carotid-cavernous fistula, dural arteriovenous malformations, therapy

Abstract

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.

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References

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.

How to Cite
1.
Cvenkel B, V. Dolenc V, Miloševič Z. DURAL CAROTID-CAVERNOUS FISTULAS. ZdravVestn [Internet]. 1 [cited 18Jun.2019];71. Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1714
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Professional Article