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OBJECTIVE: The cerebral dural arteriovenous (AV) fistula is a rare cerebral vascular malformation. Clinical presentation varies from asymptomatic to acute intracranial bleeding. Classification is based on the venous drainage with a risk assessment of bleeding. The carotid-cavernous fistula is a subtype with its own classification and treatment approaches.
CONCLUSIONS: Nowadays, dural fistulas can be diagnosed using high-resolution and time-resolved tomographic methods. Catheter angiography with subsequent interdisciplinary discussion should be performed for precise classification and therapy planning. Both endovascular and surgical treatment methods are available.
UNASSIGNED: KLINISCHES PROBLEM: Die zerebrale durale arteriovenöse (AV) Fistel zählt zu den seltenen zerebralen Gefäßmalformationen. Das klinische Erscheinungsbild variiert von kompletter Beschwerdefreiheit im Sinne eines Zufallsbefunds bis hin zu einer akuten intrakraniellen Blutung. Die Klassifikation erfolgt anhand der venösen Drainage mit Einschätzung des Blutungsrisikos. Als besonderer Subtyp zählt die Carotis-cavernosus-Fistel mit eigener Klassifikation und Behandlungsansätzen. EMPFEHLUNGEN FüR DIE PRAXIS: Die Durafisteln können heutzutage bereits mit den hoch- und zeitauflösenden Schnittbildverfahren erkannt werden. Zur exakten Klassifikation und Therapieplanung sollte eine Katheterangiographie durchgeführt werden mit anschließender interdisziplinärer Besprechung. Es stehen sowohl endovaskuläre als auch chirurgische Therapieverfahren zur Auswahl.

The combination of ipsilateral sixth nerve palsy (6NP) and Horner\'s syndrome (Horner\'s) is a localizing sign of an injury to the posterior cavernous sinus. The presentation and clinical course of 3 patients presenting with coexisting ipsilateral 6NP and Horner\'s as a result of carotid cavernous sinus fistulas (CCFs) are discussed in this case series. We highlight these cases to show the possible sequence of events: (i) simultaneous discovery of 6NP and Horner\'s, (ii) 6NP followed by Horner\'s, and (iii) Horner\'s followed by 6NP. It is important to carefully assess for Horner\'s in patients with 6NP as this has high localizing value. In patients with a red eye consistent with a CCF, identifying Horner\'s also has high localizing value and can confirm the suspicion of a CCF. Clinicians should recognize that although 6NP and Horner\'s localize to the cavernous sinus and may be due to a CCF, they may appear in isolation or sequentially. It is also important to understand that Horner\'s and 6NP have different prognoses: 6NP usually resolves over time, whereas Horner\'s tends to persist.

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UNASSIGNED: The aim of this research was to describe a single-center practical experience in the management of traumatic carotid cavernous fistula (CCF).
UNASSIGNED: There were a total of 31 patients between January 2005 and December 2019 with post-traumatic carotid cavernous sinus fistula (tCCF) who underwent treatment. We classified them into 2 types according to the flow of the CCF: patients with high flow CCF and patients with low flow CCF.
UNASSIGNED: Angiography revealed the high flow types on 21 patients (67.7%), the mean of patients ages are 31.5 years. Onyx embolization was performed in 1 patient (4.76%), transarterial balloon embolization was carried out in 10 patients (47.61%), transarterial coiling in 3 (14.28%) patients while 5 (28.8%) patients underwent transvenous routes to insert the coil and 2 patients (9.52%) were treated conservatively. Complete occlusion was achieved on all patients with coiling whereas the other treatment experiences the reducing flow of the fistula. We obtained 10 patients (32.2%) with a mean of 40.3 years as low flow type CCF. The patients with the low flow type mostly treated conservatively, because their symptoms were acceptable and intermittent.
UNASSIGNED: The ballooning currently became the more affordable treatment in our center. Balloon embolization was recommended for medium- and large-size fistula. The coils should be recommended for small-size fistula. In some cases occlusion of the fistula cannot be obtained using the detachable balloon, a coil can be used to occlude the cavernous sinus via trans arterial or trans venous access. If the fistula failed to be treated in traditional ways using balloons or coils, occlusion of the parent vessels could be another option.

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Background and objectives: Spontaneous carotid-cavernous fistulas (CCFs) are rare, and they may be caused by an aneurysm rupture. Materials and Methods: A case of a man hospitalized for high-intensity hemicranial headache with sudden cough onset as part of an upper respiratory tract infection is presented. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. Neurological finding registered a wider rima oculi to the right and slight neck rigidity. Laboratory findings detected a mild leukocytosis with neutrophil predominance, while cytobiochemical findings of CSF and a computerized tomography (CT) scan of the endocranium were normal. Results: Magnetic resonance imaging (MRI) angiography indicated the presence of a carotid cavernous fistula with a pseudoaneurysm to the right. Digital subtraction angiography (DSA) was performed to confirm the existence of the fistula. The planned artificial embolization was not performed because a complete occlusion of the fistula occurred during angiographic examination. Patient was discharged without subjective complaints and with normal neurological findings. Conclusions: Hemicranial cough-induced headache may be the first sign of carotid cavernous fistula, which was resolved by a spontaneous thrombosis in preparation for artificial embolization.

A 73-year-old woman initially presented to our ophthalmology department with complaint of a red eye with gradual proptosis and mild restricted movement of the right eye who was misdiagnosed with conjunctivitis during 2 months. One week later she returned to the emergency department with a painful, swollen right eye and a high intraocular pressure of 41 mm Hg and limitation of her extraocular muscles in nearly all fields of gaze. As her IOP was high, she was diagnosed as having secondary glaucoma and was prescribed timolol 0.5% (twice a day) and Latanoprost eye drop at night in the right eye. During follow-up, her IOP remained in high level despite maximum medications. Computed tomography scan of the orbit showed an enlarged superior ophthalmic vein (SOV). In view of her persistent elevated IOP despite maximum medications and dilated conjunctival veins, she was advised digital subtraction angiography (DSA) and imaging revealed a carotid cavernous fistula (CCF). The purpose of this article is to describe ophthalmological complaints of CCFs to help ophthalmologist in understanding the clinical features of spontaneous CCF and avoid misdiagnosis.

BACKGROUND: Direct carotid-cavernous sinus fistulas (CCFs) are high-flow arteriovenous shunts that are typically the result of a severe head injury. The endovascular treatment of these lesions includes the use of detachable balloons, coils, liquid embolic agents, and covered stents. To minimize the chance of treatment failure and subsequent complications, endoluminal reconstruction using a flow-diverting stent may be added to the treatment construct.
METHODS: We present 3 cases and review the existing literature.
RESULTS: Three patients with direct traumatic CCFs were treated with either coils, coils and Onyx, or a detachable balloon, followed by placement of a flow-diverting stent for endoluminal reconstruction. All 3 cases had complete angiographic occlusion of the CCFs and recovered clinically. No complications were observed.
CONCLUSIONS: We believe that endovascular coil or balloon occlusion of the fistula from either a transvenous or transarterial approach followed by flow diversion may be an appropriate treatment for direct CCFs. This addition of a flow diverter may facilitate endothelialization of the injury to the internal carotid artery.

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