Dural arteriovenous fistulas (dAVFs) may present in a variety of ways, including as carotid-cavernous sinus fistulas. The ophthalmologic sequelae of carotid-cavernous sinus fistulas are known and recognizable, but less commonly seen is the rare clival fistula. Clival dAVFs may have a variety of potential anatomical configurations but are defined by the involvement of the venous plexus just overlying the bony clivus. Here we present two cases of clival dAVFs that most likely evolved from carotid-cavernous sinus fistulas.
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http://dx.doi.org/10.1159/000381176 | DOI Listing |
J Neurosurg Case Lessons
January 2025
The Trauma and Neuroscience Institutes, St. John's Hospital and Medical Center, Tulsa, Oklahoma.
Background: Direct carotid-cavernous fistulas (CCFs) are relatively rare but dangerous complications of penetrating traumatic brain injury or maxillofacial trauma. A variety of clinical signs have been described, including ophthalmological and neurological ones. In some cases, severely altered cerebral blood flow can present as massive life-threatening bleeding through the nose, subarachnoid hemorrhage, and/or intraparenchymal hemorrhage.
View Article and Find Full Text PDFPurpose: Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and cavernous sinus, often causing ocular symptoms like chemosis, proptosis, and diplopia. Endovascular embolization is the preferred treatment, typically performed via the transfemoral transvenous route through the inferior petrosal sinus (IPS). However, we present a case and a systematic review of indirect CCF treated through deep orbital puncture of the superior ophthalmic vein (SOV) for embolization.
View Article and Find Full Text PDFMedicina (Kaunas)
December 2024
Department of Neurosurgery, Chung Shan Medical University Hospital, Taichung City 402, Taiwan, China.
Traumatic direct type carotid cavernous fistula (CCF) is an acquired arteriovenous shunt between the carotid artery and the cavernous sinus post severe craniofacial trauma or iatrogenic injury. We reported a 46-year-old woman who had developed a traumatic direct type CCF after severe head trauma with a skull base fracture and brain contusion hemorrhage. The clinical manifestations of the patient included pulsatile exophthalmos, proptosis, bruits, chemosis, and a decline in consciousness.
View Article and Find Full Text PDFCureus
December 2024
Department of Neurosurgery, ProMedica Toledo Hospital, Toledo, USA.
A carotid cavernous fistula (CCF) is a disruption in the carotid arteries within the cavernous sinus. The pooling of blood in the sinus causes a myriad of neurological deficits. When correctly diagnosed, this condition can be easily managed through surgical intervention.
View Article and Find Full Text PDFBMJ Case Rep
December 2024
Pontificia Universidad Catolica del Ecuador, Quito, Pichincha, Ecuador.
Carotid-cavernous aneurysms (CCAs) have the potential for growth, and their risk of rupture can lead to severe complications. Treatment is typically recommended to prevent these complications, with endovascular therapy being the preferred approach due to the challenging surgical access. This case presents a rare instance of rupture of a CCA that had been previously treated with a flow-diverting stent, which resulted in the development of a carotid-cavernous fistula, requiring venous access endovascular treatment.
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