Una presentación inusual de fístula carótido-cavernosa secundaria a trauma craneoencefálico leve: reporte de caso / An unusual presentation of carotid-cavernosa fistula secondary to mild craneoenephalic trauma: a case report

Resumen La fístula carótido-cavernosa es cualquier comunicación anómala entre la arteria carótida y el seno cavernoso que genera un shunt arteriovenoso patológico, se manifiesta en forma anterógrada a la órbita, causa ceguera y oftalmoparesia. Su asociación con trauma craneoencefálico leve es escasa y poco reportada, por lo que se desconoce su prevalencia. Se reporta un paciente masculino de 54 años proveniente de Cali, Colombia, con antecedente de trauma craneoencefálico leve 2 meses antes del ingreso, quien presenta cuadro de cefalea holocraneal y alteraciones visuales. Al examen físico presentó oftalmoparesia, con ptosis palpebral bilateral asimétrica y proptosis pulsátil izquierda; se realizó resonancia magnética cerebral simple y angioresonancia, con hallazgos sugestivos de fístula carótido-cavernosa. El paciente fue llevado a arteriografía más embolización, logrando un resultado favorable. La presencia de cefalea con banderas rojas, alteraciones visuales, proptosis pulsátil y el antecedente de trauma craneoencefálico, sin importar su grado, pueden hacer sospechar la presencia de esta entidad.

Abstract The carotid-cavernous fistula is any abnormal communication between the carotid artery and the cavernous sinus, generating a pathological arteriovenous shunt manifesting anterograde to the orbit, causing blindness and ophthalmoparesis. Its association with mild head trauma is scarce and underreported, its prevalence being unknown. A 54-year-old male patient from Cali - Colombia is reported, with a history of mild cranioencephalic trauma 2 months ago, who consulted for a holocranial headache and visual disturbances. On physical examination he presented ophthalmoparesis, with bilateral asymmetric palpebral ptosis with left pulsatile proptosis. A simple brain magnetic resonance and angio-MRI was performed, with findings suggestive of a carotid-cavernous fistula. The patient was taken to arteriography plus embolization, achieving a favorable result. The presence of headache with red flags, visual disturbances, pulsatile proptosis, and a history of head trauma, regardless of its degree, can lead to suspect the presence of this entity.

Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula

PURPOSE: We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF). CASE SUMMARY: A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a −4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed. CONCLUSIONS: Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.

Delayed contralateral traumatic carotid cavernous fistula after craniomaxillofacial fractures

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

Willis covered stent in the treatment of traumatic carotid cavernous fistulae:a report of 7 cases / 国际脑血管病杂志

Objective To evaluate the efficacy and safety of Willis covered stent in the treatment of traumatic carotid cavernous fistulae (tCCF).Methods The imaging and clinical data of 7 patients with tCCF treated with Willis covered stent in Shanghai Punan Hospital from November 2015 to June 2018 were analyzed retrospectively.Results Seven Willis covered stent were used in 7 patients.Immediately after stent release,angiography showed that the fistulae completely disappeared in 6 cases.One patient had a small amount of endoleak,and there was still a small amount of endoleaks after balloon dilatation.It was not further treated.There were no operative complications.During 3-12 months follow-up,no new neurological deficits were found in all patients.Angiographic follow-up of 2 patients showed that the fistulae completely disappeared without recurrence.The internal carotid arteries were patent,no in-stent stenosis and stent displacement.Conclusions Wills covered stent can be used as a treatment for tCCF.Its efficacy is satisfactory and the safety is good.

Efficacy evaluation of embolization with Scepter balloon-assisted coils and Onyx glue for traumatic carotid cavernous fistula / 中华创伤杂志

Objective To evaluate the efficacy and safety of embolization with Scepter balloonassisted coils and Onyx glue in treatment of traumatic carotid cavernous fistula (TCCF).Methods A retrospective case series study was conducted on the clinical data of 24 patients with TCCF managed with embolization with Scepter balloon-assisted coils and Onyx glue from February 2012 to February 2017.There were 20 males and 4 females,aged 21-65 years [(42.6 ± 6.8) years],with Glasgow coma scale (GCS) of 15 points.All patients were with unilateral lesions,with 13 on the right and 11 on the left.Among TCCF patients,23 patients were with cranial bruit,22 with pulsating exophthalmos and bulbar conjunctiva congestion edema,19 with orbital symptoms,and 9 with visual impairment.A micro-catheter was sent into the cavernous sinus of lesion side,and the location of traumatic carotid cavernous fistula and draining characteristics were identified by micro catheter contrast.With a balloon inflated to cover the fistula and protect the interual carotid artery,Onyx was injected into the cavernous sinus after several coils were deployed adjacent to the fistula until the complete occlusion of fistula.Cranial bruit,pulsating exophthalmos,visual impairment,and orbital symptoms before operation and 2 weeks after operation were observed.Six months after operation,digital subtraction angiography (DSA) was reviewed to evaluate the carotid artery patency and TCCF recurrence.Results The cranial bruit,pulsating exophthalmos,and bulbar conjunctiva congestion edema in all TCCF patients disappeared 2 weeks after operation.No obvious improvement was seen in 2 out of 9 patients with visual impairments and 2 out of 19 patients with orbital symptoms,but there was significant improvement after operation (P ＜ 0.05).Onyx glue adhering to the surface of the protective balloon occurred in one patient.The balloon and catheter were delivered to the external carotid artery and then removed,with no complication seen.Follow-up found no recurrence or operative complications in 6-12 months.Complete occlusion of fistula was seen in all patients,and the internal carotid artery showed good patency.Conclusion Embolization with Scepter balloon-assisted coils and Onyx glue can occlude fistula,eliminate ocular symptoms,and maintain internal carotid artery patency and hence is an effective and safe treatment option for TCCF.

Fistula carótido-cavernosa unilateral con síntomas neuro-oftalmológicos bilaterales e infarto cerebral venoso: Reporte de un caso / Carotid-cavernous fistula with bilateral neuro-ophthalmologic symptoms and venous ischemia: A case report

La fistula carótido-cavernosa es una comunicación anómala entre la arteria carótida y el seno cavernoso que provoca un shunt arteriovenoso patológico y cuyo origen es traumático o espontáneo. Las manifestaciones clínicas están relacionadas con el cambio de dirección del drenaje venoso y del flujo sanguíneo a través de la fístula e incluyen síntomas oculares tales como quemosis, exoftalmos y soplo orbitario, además de manifestaciones neurológicas como infartos venosos y hemorragias intracerebrales. Su presencia se confirma mediante la angiografía por sustracción digital (ASD) y la clasificación generalmente aceptada se basa en la propuesta por Barrow. El tratamiento endovascular ha sido el enfoque terapéutico preferido durante las últimas dos décadas; sin embargo, el tratamiento quirúrgico sigue siendo una opción cuando aquél falla o no está disponible. Se reporta el caso de una paciente de 71 años de edad, con antecedente de traumatismo cráneo-encefálico en la que se diagnósticó fístula carótido-cavernosa izquierda y síntomas neuro-oftalmológicos bilaterales asociados a un infarto venoso a nivel temporal izquierdo. La paciente fue intervenida quirúrgicamente y presentó una evolución clínica favorable.

The carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus that induces a pathological arterio-venous shunt, and whose origin may be traumatic or spontaneous. Its clinical symptoms are related to changes in the direction of the venous drainage and blood flow through the fistula, and include ocular symptoms as chemosis, exophthalmos and orbital murmur besides neurological manifestations such as venous infarctions and intracerebral hemorrhage. Its presence is confirmed by digital subtraction angiography and the generally accepted classification is based on Barrow'se proposal. Endovascular treatment has been the preferred treatment approach for the past two decades; however, surgical treatment remains an option when the former fails or is not possible. The case of a 71 year-old woman with a history of traumatic brain injury is reported: the patient was diagnosed with carotid-cavernous fistula and bilateral neuro-ophthalmic symptoms associated with left temporal venous infarction, and underwent surgical treatment with a favorable clinical outcome.

Endovascular treatment of carotid-cavernous vascular lesions / Tratamento endovascular das lesões vasculares carótido-cavernosas

ABSTRACT Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction.

RESUMO Objetivo: avaliar o tratamento endovascular de lesões vasculares da artéria carótida interna (ACI), segmento cavernoso, realizado na Santa Casa de São Paulo. Métodos: estudo descritivo, retrospectivo e prospectivo, de pacientes com aneurisma da porção cavernosa da ACI ou com fístulas carótido-cavernosas diretas (FCCd) submetidos a tratamento endovascular. Resultados: foram incluídos 26 pacientes com aneurismas intracavernosos e dez com FCCd. Todos os aneurismas foram tratados com oclusão da ACI. Os com FCCd foram tratados com oclusão, em sete casos, e com oclusão seletiva da fístula nos outros três. Houve melhora da dor e proptose ocular em todos os pacientes com FCCd. Nos pacientes com aneurisma intracavernoso, a incidência de dor retro-orbitária caiu de 84,6% para 30,8% após o tratamento. Após o tratamento endovascular houve uma melhora importante da disfunção de nervos cranianos afetados em ambos os grupos, sobretudo no nervo oculomotor. Conclusão: o tratamento endovascular trouxe melhora para os pacientes deste estudo, especialmente nos critérios dor e acometimento do nervo oculomotor.

Advances in the endovascular treatment of direct carotid-cavernous fistulas / Avanços no tratamento endovascular de fístulas carotidocavernosas diretas

SUMMARY Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.

RESUMO As fístulas carotidocavernosas (FCC) são comunicações anormais entre a artéria carótida e o seio cavernoso. Elas são consideradas diretas quando há uma comunicação direta entre a artéria carótida interna e o seio cavernoso. Nesses casos, são geralmente traumáticas. As FCC diretas são lesões de alto fluxo, podendo estar relacionadas a sangramento intracraniano, perda visual, exposição corneana ou até mesmo a epistaxe fatal. Seu tratamento é sempre indicado. O tratamento ideal da FCC direta é a exclusão da fístula da circulação, com preservação do fluxo carotídeo. Isso pode ser obtido por meio de técnicas endovasculares diversas. O objetivo do presente artigo é realizar uma revisão sobre as FCC diretas, com especial enfoque nas opções de tratamento endovascular disponíveis na atualidade.

Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent

We report the case of a recurrent carotid cavernous fistula (CCF) originating from a giant cerebral aneurysm (GCA) after placement of a covered stent. A 47-year-old woman presented with sudden onset of severe headache, and left-sided exophthalmos and ptosis. Cerebral angiography revealed a CCF caused by rupture of a GCA in the cavernous segment of the left internal carotid artery. Two covered stents were placed at the neck of the aneurysm. The neurological symptoms improved at first, but were aggravated in the 6 months following the treatment. Contrast agent endoleak was seen in the distal area of the stent. Even though additional treatments were attempted via an endovascular approach, the CCF could not be cured. However, after trapping the aneurysm using coils and performing superficial temporal artery-middle cerebral artery bypass, the neurological symptoms improved. In cases of recurrent CCF originating from a GCA after placement of a covered stent, it is possible to treat the CCF by endovascular trapping and surgical bypass.

Delayed Traumatic Carotid-Cavernous Sinus Fistula Accompanying Intracranial Hemorrhage

Traumatic carotid-cavernous fistula (TCCF) is a pathologic communication between the internal carotid artery and cavernous sinus, and is associated with craniomaxillofacial trauma. TCCF are very rare, occurring in 0.17~0.27% of craniomaxillofacial trauma cases. We describe a 76-year-old woman treated for multiple fractures including the skull base, left temporal bone, right tibia and fibula, left clavicle, and fifth and seventh rib fractures. She developed symptoms of TCCF two weeks after the initial trauma. We successfully treated her by endovascular occlusion of the internal carotid artery.

Endovascular embolization for traumatic carotid cavernous fistula:a retrospective case series study of 20 cases / 国际脑血管病杂志

Objective To evaluate the clinical effect of endovascular embolization for traumatic carotid cavernous fistula (TCCF).Methods In 20 patients with TCCF,10 were treated with the detachable balloon embolization,4 were treated with the detachable balloon embolization and coils,2 were treated with coils alone,3 were treated with coils and Onyx,and 1 was treated with covered stenting.Two of them were embolized again because of leaking balloon.Results Eighteen of the 20 patients were embolizeded successfully once,2 were embolizeded successfully twice.The patency rate of internal carotid artery was 100％.No operation-related complications occurred.Conclusions Endovascular embolization is a simply,safe and reliable method of curative effect for the treatment of TCCF.

Clinical value of Dyna CT in evaluating direct carotid-Cavernous fistula / 第二军医大学学报

To discuss the clinical value of diluted contrast enhanced Dyna CT in evaluating direct carotid-cavernous fistula(DCCF). Methods The clinical data of 16 patients with traumatic and solo fistulous DCCF were retrospectively studied. The images by 3D rotatory digital subtraction angiography (3D-DSA) and diluted contrast enhanced Dyna CT were used for comparison and analysis of their values for diagnosis of DCCF. The comparison items included information on the orificium fistulae, the retrograde leptomeningeal venous drainage (RLVD), the draining veins and the compartment of the cavernous sinus. Results Compared with 3D rotatory DSA, Dyna CT demonstrated 21 more findings in 15 patients (93.75%), including the detection of the orificium fistulae (n=8), the RLVD (n=2), the draining veins (n=2), and compartment of the cavernous sinus (n=9), with significant difference found between Dyna CT and 3D-DSA in revealing the orificium fistulae and compartment of the cavernous sinus (P<0.05), while not in revealing RLVD and the draining veins. Conclusion Compared with 3D-DSA, Dyna CT can more effectively demonstrate the orificium fistulae and compartment of the cavernous sinus of DCCF, which may benefit the clinical diagnosis and treatment of DCCF.

A Case of the Carotid-Cavernous Fistula Due to the Internal Carotid Artery Injury During Endoscopic Sinus Surgery

Rupture of the internal carotid artery (ICA) during endoscopic sinus surgery is a rare complication. However, it can potentially result in death within minutes. In the event of a traumatic injury to the ICA during sphenoid sinus exploration, it is very difficult to control the bleeding. We present a case of carotid-cavernous fistula after an accidentally-developed ICA bleed during endoscopic sphenoidotomy. The patient was successfully treated with endovascular embolization techniques that included detachable microcoils.

The analysis of influence factor on the recovery time of oculomotor nerve palsy after traumatic carotid-cavernous sinus fistula treated by balloon embolization / 中国医师进修杂志

Objective To investigate the influence factor of the recovery time of oculomotor nerve palsy (ONP) after traumatic carotid-cavernous sinus fistula (TCCF) treated by balloon embolization.Methods The clinical data of 76 patients with ONP after TCCF were retrospectively analyzed.All patients accepted intravascular balloon embolization treatment.Nonparametric test was applied to make single factor analysis of the influence factor of ONP recovery time,and linear regression analysis was applied to make multiple factor analysis.Results Seventy-six patients (100.0％) had a perfect occlusion for orificium fistulae after operation immediately,and 73 patients (96.1％) retained the internal carotid artery.Patients were followed up for 6-70 months,with an average of 34.2 months and no death cases.Seventy patients (92.1％) succeeded for embolization at the first time,and 6 patients (7.9％) relapsed after embolization for 6 weeks.The reasons of relapse was balloon leak,and no patients recurred after twice embolization.Seventy-six patients (100.0％) had recovery from ONP,and recovery time was (42.17 ± 32.39) d.The single factor analysis showed that the courses of diseases,fistula location,eye-tubercle location,degree of ONP,balloon quantity,state of internal carotid artery were the factor affecting the ONP recovery time (P ＜ 0.01 or ＜ 0.05).The linear regression analysis showed that the courses of the disease,fistula location,degree of ONP,balloon quantity were independent factor affecting the ONP recovery time (P ＜ 0.01).Conclusions Intravascular balloon embolization in the treatment of ONP after TCCF is safe and reliable.The courses of diseases,fistula location,degree of ONP and balloon quantity are the influencing factor of the oculomotor nerve functional recovery time,and should be given enough attention.

Fístula carotídeo-cavernosa / Carotid-cavernous fistula

Fístulas carotídeo-cavernosas são raras. São classificadas nos tipos direto e indireto. Fístulas diretas têm uma comunicação anormal entre a artéria carótida interna e o seio cavernoso. Nas formas indiretas a conexão se faz entre os ramos meningeos da carótida interna e/ou externa e o mesmo seio. O propósito deste artigo é o de atualizar os conceitos anatômicos, clínicos, diagnósticos e terapêuticos desta situação.

Carotid cavernous fistulae are an uncommon disease. They are classified as direct or indirect. In direct fistulas there is an abnormal communication between the internal carotid artery and the cavernous sinus. Indirect forms have an abnormal bypass between the meningeal branches of the internal and/or external carotid arteries and the same sinus. The purpose of this article is to provide an overview of the anatomy of the envolved area and the clinical findings, diagnostic evaluation and treatment.

Balloon embolization therapy for traumatic carotid cavernous fistula / 中华创伤杂志

Objective To analyze effect of balloon embolization therapy for traumatic carotid cavernous fistula (TCCF),so as to provide references for treatment of this disease.Methods A total of 21 patients with TCCF managed with balloon embolization from April 2006 to March 2012 were collected in the study.There were 17 males aged (32.3 ±5.4) years and 4 females aged (40.6 ±5.8)years.Perioperative clinical presentations and imageologic changes were observed as well as operative outcome was evaluated.Results After 3 months of follow-up,20 patients experienced successful detachable balloon embolization,but the other one patient had to have stent angioplasty due to the failure of the procedure.All patients had some improvements on clinical presentations after operation (P ＜ 0.05).Imageologic examination revealed that all patients had complete occlusion of TCCF following operation.In follow-up,one patient had a relapse,with total curative ratio of 95％.Conclusions Detachable balloon embolization is effective in treatment of TCCF.Presently,the technique is an optimal method for such kind of disease and is worthy of wide clinical use.

Endovascular treatment of iatrogenic pseudoaneurysm and delayed carotid-cavernous fistula following trans-sphenoidal surgery / Tratamiento endovascular de pseudoaneurisma y fístula carótida-cavernosa iatrogénica después de la cirugía trans-esfenoidal

Lesiones accidentales de la arteria carótida son complicaciones poco frecuentes de diversos procedimientos diagnósticos y terapéuticos. Representan una condición grave y potencialmente mortal si el tratamiento no se realiza adecuadamente. Un paciente de sexo femenino, 45 años de edad, que ingresó en el servicio de Otorrinolaringología con queja de la disminución de la agudeza auditiva y acúfenos en el oído izquierdo. La resonancia magnética encefálica mostro una formación expansiva / infiltrativa a comprometer desde la nasofaringe izquierda hasta la base del cráneo, con la participación de la arteria carótida interna (ACI) en el mismo lado en su segmento petroso. Durante el procedimiento de biopsia, se produjo una laceración en la carótida derecha intracavernosa con sangrado abundante. Se realizó un taponamiento local y el paciente fue remitido a la angiografía cerebral que mostró un seudoaneurisma en la arteria carótida interna derecha en su segmento cavernoso. Después de una prueba de oclusión, la ACI derecha fue ocluida por 2 globos. Tres semanas después, el estado del paciente mostró empeoramiento progresivo de la agudeza visual, proptosis ocular, hiperemia conjuntival y la restricción del movimiento ocular en el ojo derecho. Una nueva angiografía fue realizada y mostró la persistencia de la oclusión de la ACI en su origen y un seudoaneurisma asociado con fístula carótido-cavernosa derecha, que se opacificado después de la inyección de contraste en la ACI izquierda, a través de la arteria comunicante anterior. El paciente fue sometido a un nuevo tratamiento endovascular con resolución de la lesión. Laceración de ACI durante la cirugía transesfenoidal es una complicación rara y potencialmente fatal. La prevención es el mejor tratamiento para cualquier lesión accidental. La utilización de técnicas endovasculares ha permitido para el tratamiento satisfactorio de esta condición.

Accidental carotid artery lesions are uncommon complications from diverse diagnostic and therapeutic procedures. It represents a grave and potentially lethal condition if treatment is not adequately performed. A female patient, 45 years old, who was admitted to the Otolaryngology service complaining of diminished auditory acuity and tinnitus in the left ear. The encephalic magnetic resonance imaging (MRI) showed an expansive/infiltrative formation compromising the left nasopharynx to the skull base, involving the ipsilateral internal carotid artery (ICA) in its petrous segment. During the biopsy procedure, there was a right intracavernous ICA laceration with copious bleeding. A local tamponade was performed and the patient was referred to cerebral angiography (CAG), which showed a right ICA pseudoaneurysm in its intracavernous segment. After a balloon occlusion test, the right ICA was occluded by 2 balloons. Three weeks after, the patient’s condition showed progressive worsening of visual acuity, occular proptosis, conjuctival hyperemia and occular movement restriction in the right eye. A new CAG was performed and showed persistence in the right ICA occlusion in its origin and an intracavernous pseudoaneurysm associated with ipsilateral carotidcavernous fistula, which became opacified after contrast injection in left ICA, through the anterior communicating artery. The patient was submitted to a new endovascular treatment with lesion resolution. ICA laceration during transsphenoidal surgery is a rare and potentially fatal complication. The prevention is the best treatment for any accidental lesion. Utilization of endovascular techniques has allowed for satisfactory treatment of this condition.

Long term follow up of carotid cavernous fistula patients treated with carotid occlusion / 中华放射学杂志

ObjectiveTo explore efficacy,durability and possible impacts on life quality of carotid occlusion treatment to carotid cavernous fistula (CCF) patients.MethodsCCF patients since 2001 were retrospectively analyzed,the clinical features,2 weeks post procedure mRS score and ratio of carotid occlusion were recorded.Headache impact test (HIT-6) and Short form health survey(SF-36) were used to assess impact of sequelae in patients' daily life,by phone call,questionnaire and clinic recheck.Results Total 96 cases were studied composed of 81 direct CCF and 15 dural AVF.Thirty-two direct CCF cases underwent carotid occlusion during procedure and many ophthalmologic signs but visual impairment got recovery after 2 weeks,the mRS score less than 2 were revealed.The one year post operation HIT-6 score more than 50 was more likely found in carotid occlusion cases comparing with those preserved carotid artery while the 3 year SF-36 scores of carotid occlusion cases revealed inferior to those with patent artery,especially in body pain,general health and vitality subscales.ConclusionCarotid occlusion seems to be a feasible,effective and durable alternative for CCF treatment,but which could play a negative role on quality of patients' life in the long run.

Fístulas carótido-cavernosas: resultados clínico y angiográfico de los pacientes tratados por el Grupo de Neurorradiología del Hospital Universitario San Vicente de Paúl, 1995-2007, Medellín, Colombia / Carotid-cavernous fistulae: Clinical and angiographic results in patients treated by the Neuro-radiology Group at a third-level University Hospital in Medellín, Colombia, 1995-2007

Introducción: las fístulas carótido-cavernosas son frecuentes en Medellín, Colombia, y su tratamiento quirúrgico se asocia a tasas elevadas de complicaciones debido a las características anatómicas peculiares de esta zona; por ello la terapia endovascular ha surgido como la primera opción de tratamiento para los pacientes con este trastorno. Objetivo: describir las principales características de un grupo de pacientes con fístulas carótido-cavernosas, el procedimiento terapéutico empleado y los resultados clínicos y angiográficos obtenidos. Pacientes y métodos: se revisaron retrospectivamente las historias clínicas de 51 pacientes tratados por el grupo de Neurorradiología del Hospital Universitario San Vicente de Paúl, entre los años 1995 y 2007. Se tuvieron en cuenta algunas variables demográficas, la etiología de la fístula, el estado clínico inicial y final, el tipo de fístula, el método terapéutico empleado y los resultados angiográficos. Resultados: se encontró un total de 51 pacientes, tres de ellos con fístulas bilaterales para un total de 54 fístulas; sin embargo, las fístulas de dos pacientes se resolvieron espontáneamente y la de otro se resolvió con masaje carotídeo. Por ello el tratamiento endovascular se hizo en solo 48 pacientes. El promedio de edad fue de 35 años, con predominio del sexo masculino (74,5%). Las fístulas fueron traumáticas en 47 pacientes (92,2%), y espontáneas en cuatro (7,8%); de los 47 pacientes con fístulas traumáticas, en 33 (70,2%) se originaron por trauma cerrado, en 12 (25,5%) por heridas con arma de fuego, y en dos (4,3%) por herida con arma cortopunzante. Las manifestaciones clínicas encontradas en orden descendente de frecuencia fueron: quemosis, proptosis, soplo, dolor, disminución de la agudeza visual y sangrado intracraneal. Según la clasificación de Barrow, las fístulas fueron de tipo A en el 86,0% de los casos, de tipo B en el 9,8%, de tipo C en el 1,9% y de tipo D en el 1,9%...

Introduction: Carotid-cavernous fistulae are frequently found in Medellín, Colombia and their surgical treatment associates with a high rate of complications due to the peculiarities of this anatomic zone. Endovascular therapy has become the first option in patients with these lesions. Objective: to describe the main demographic, clinical and angiographic features of a group of patients with carotid-cavernous fistulae, the therapeutic approach used in them, and the results obtained from the clinical and angiographic standpoints. Patients and methods: We reviewed the clinical charts of 51 patients treated by the Neuro-radiology Group at Hospital Universitario San Vicente de Paúl, in Medellín, Colombia, between 1995 and 2007. The following information was taken into account: demographic variables, etiology, initial and final clinical situation, therapeutic procedures, and angiographic results. Results: A total of 51 patients were found, three of which had bilateral lesions. Two patients had spontaneous resolution of their fistulae and in one more it resolved with carotid massage. Endovascular treatment was therefore carried out in only 48 patients. Average age was 35 years, and 74.5% of the patients were males. Fistulae were traumatic in 47 patients (92.2%) and spontaneous in four (7.8%). Out of the 47 traumatic fistulae, 33 (70.2%) were due to closed cranio-encephalic trauma. In 12 they were produced by firearm wounds and in two they were due to wounds with sharp instruments. In decreasing order of frequency clinical manifestations were: chemosis, proptosis, murmur, pain, decreased visual acuity and intracranial bleeding. Concerning the type of fistula (Barrow classification), they were type A in 86.0%, type B in 9.8%, type C in 1.9% and type D in 1.9%...