Characteristics and Surgical Repair Outcomes of Obstetric Fistula Patients Managedata Teaching Hospital in Zambia: A Retrospective Cross-Sectional Study

BackgroundThe obstetric fistula is a chronic maternal morbidity of global public health concern. The condition is preventable and, in most cases, treatable. Surgicalrepairis themainstay of treatment with varying degrees of success. The aim of this study was to determine the characteristics, surgical outcomes and factors influencing surgical outcomes of women presenting with obstetric fistulas at a Teaching Hospital in Lusaka, Zambia. Methods: Aretrospective review of medical records for all women who underwent obstetric fistula repair surgeryat Women and Newborn Hospital from 2017 to 2019. Descriptive analysis was done. Fischer's exact test was used to measure association between surgical outcomes and variables in the model.: ResultsIn total,18 out of 29 records of patients who underwentfistularepairwereretrievedandanalyzed. Ages ranged from 15 to 47 years, mean age 29years.Overtwothirds(72.23%)weremultiparous, and over 3/4ths (77.8%) underwent caesarean section in the antecedent pregnancy. Success rate for fistula repair was 83%at 2 weeks post-operative.Study findings were inadequate to show a significant association between successful repair and factors in the model. Conclusion: Majority of women presenting with obstetric fistula were multiparous with a history of prolonged labour, delivery by caesarean section and poor birth outcomes. Success rate for obstetric fistula repair at Women and Newborn Hospital was 83% at 2weeks postoperative. Further studies are needed to assess long-term outcomes and factors influencing surgical outcomes.:

Surgical Treatment of Carotid-cavernous Fistula Performed through the Brazilian Unified Health System

Introduction The carotid-cavernous fistula (CCF) is an abnormal communication between the arterial carotid system and the cavernous sinus. In most cases, spontaneous fistulas are due to the rupture of intracavernous carotid artery aneurisms. Traumatic fistulas occur in 0.2% of head injuries, and 75% of all CCFs are caused by automobile accidents or penetrating traumas. Objective To identify the data regarding the number of annual procedures, hospital expenses, length of hospital stay, and the number of deaths of patients admitted by the Brazilian Unified Health System (SUS, in the Portuguese acronym), in the period between 2007 and 2017, using the surgical code of the surgical treatment for CCF. Methods The present was an ecological study whose data were obtained by consulting the database provided by the Department of Computer Sciences of the Brazilian Unified Health System (Datasus, in Portuguese). Results A total of 85 surgical procedures were performed for the treatment of CCFs from January 2007 to October 2017 through the Unified Health System (SUS, in Portuguese), and there was a reduction of 71.42% in this period. The annual incidence of patients undergoing this surgical treatment during the period observed remained low, with 1 case per 13,135,714 in 2007, and 1 case per 51,925,000 in 2017. Conclusion Despite the low annual incidence of the surgical treatment of CCFs performed by the SUS in Brazil in the period of 2007­2017, based on the data obtained on the average length of stay and expenditures in hospital services, it is necessary that we develop an adequate health planning.

Uso do doppler colorido das carótidas no diagnóstico de um paciente com fístula carotideocavernosa direta / Use of color doppler of carotids in the diagnosis of a patient with direct carotid-cavernous fistula

Adulto jovem de 18 anos que evoluiu após traumatismo craniencefálico leve com fístula carotídea direta. Apresentou zumbido e exoftalmia, ambos de característica pulsátil e à esquerda. Foi submetido a estudo com Doppler das carótidas, que mostrou elevadas velocidades do fluxo sanguíneo e índices de resistência reduzidos nas artérias carótidas comum e interna esquerdas, compatíveis com fístula carotídea direta. A angiotomografia computadorizada cerebral confirmou a fístula carotídea. Foi encaminhado para tratamento endovascular por embolização, com sucesso. O Doppler de carótidas pode ter papel importante no diagnóstico das fístulas carotídeas diretas e acompanhamento de pacientes submetidos à terapêutica endovascular.(AU)

Direct carotid-cavernous fistula in a Filipino female presenting with simultaneous orbital/ocular, cavernous and cortical symptomatology without history of trauma: A case report

@#Carotid-cavernous fistula (CCF) is a rare and dangerous neurological disorder that arises due to an abnormal communication between the internal carotid artery (ICA) or the external carotid artery (ECA) and their branches and the cavernous sinus. It can either be a direct fistula (high-flow with acute symptoms) most commonly resulting from trauma (70-90%) or an indirect fistula (low-flow with insidious symptoms) secondary to hypertension, atherosclerosis and collagen vascular disorders. The shunting of arterial blood into the venous system leads to venous hypertension causing various clinical manifestations depending on the venous drainage patterns and the shunt flow. Increased anterior, posterior and superior venous drainage results to orbital/ocular, cavernous and cortical symptomatology, respectively. This paper aims to present a case of 58-year old Filipino female with a 2-day history of sudden, severe headache, vomiting and blurring of vision followed by decrease in sensorium and sudden proptosis and chemosis of the left eye. Patient had no co-morbidities, history of trauma, surgeries, facial skin infections or prior febrile illness. The left eye had exophthalmos, subconjunctival hyperemia, scleral edema/chemosis and ocular bruit. Neurologic examination showed a stuporous patient with multiple cranial nerve deficits (impaired direct and consensual pupillary reflex left, complete ptosis left, sluggish corneal reflex left, impaired oculocephalic reflex left), right hemiplegia and meningeal signs. Cranial Computed Tomography (CT) Angiogram revealed an acute parenchymal hemorrhage in the left frontotemporal lobe with subarachnoid component, with engorged left cavernous sinus and dilated left superior ophthalmic vein. Digital Subtraction Angiography (DSA) was done revealing a direct type of left carotid-cavernous fistula with massive ICA shunting to the cavernous sinus, superior ophthalmic vein and inferior petrosal sinus. The clinical and radiographic evidence were consistent with a Direct/Type A CCF. Unique in this case was a patient with no history of trauma presenting with simultaneous orbital/ocular, cavernous and cortical symptomatology – a clinical picture of CCF that has never been documented in any literature nor included in any classification system. The presence of all three symptomatology can be explained by a direct/highflow fistula that resulted to increased anterior, posterior and superior venous drainage as documented in the DSA. In addition, spontaneous intracranial hemorrhage in CCF is exceptionally rare and it is the most daunting symptomatology of this disease. With that, this specific case may pave the way to a new classification scheme and determine its corresponding treatment approach.

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.

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.

Imaging findings and outcomes in patients with carotid cavernous fistula at Inkosi Albert Luthuli Central Hospital in Durban

Background: Carotid cavernous fistulas (CCFs) are relatively uncommon and are difficult to diagnose clinically. Radiological imaging plays a significant role in making the diagnosis with recent advances improving the ability of radiologists to diagnose the condition. Despite these developments, digital subtracted angiography (DSA) remains the gold standard in diagnosing CCFs and simultaneously provides the opportunity for intervention. Objectives: To determine the imaging findings of patients presenting to Inkosi Albert Luthuli Central Hospital (IALCH) with a CCF and to assess the outcome of endovascular intervention. Method: We reviewed the electronic records and archived imaging data of consecutive patients diagnosed with CCF between January 2003 and May 2016 at IALCH, in particular, the imaging findings, intervention and subsequent outcomes. Results: Computed tomography (CT) was the most utilised imaging modality prior to patients undergoing DSA. A dilated superior ophthalmic vein (96%) was the most prevalent imaging finding on axial imaging. At DSA, all except two patients had high-flow fistulas. The fistulas predominantly drained anteriorly (69.44%) and a cavernous internal carotid artery aneurysm was identified in eight patients. Occlusion of the fistula was attained in all patients that were compliant with follow-up and underwent intervention (n= 36, 100%), but parent artery sacrifice was required in 10 cases (27.78%). Conclusion: A wide range of imaging modalities can be used in the workup of a CCF. CT is currently the most accessible modality in our setting, with limited access to magnetic resonance imaging. On axial imaging, a dilated superior ophthalmic vein is the commonest finding. Classification of a fistula according to flow dynamics and noting the presence of aneurysms or pseudoaneurysms was found to be more practical in comparison to the traditional Barrow's classification. Management outcomes at our institution compare well with available local and international data

Síntomas neurológicos de fístula carotídeo carvenosa: reporte de caso / Neurological symptoms of cavernous carotid fistula: case report

RESUMEN Las fístulas carótido-cavernosas son comunicaciones anormales entre la arteria carótida interna o externa; o alguna de sus ramas (sistema arterial) y el seno cavernoso (sistema venoso); el espectro de presentación de esta entidad es muy variable, sin embargo existe un gran número de pacientes en los cuales los síntomas neurológicos conllevan a sospecha clínica. Los síntomas pueden variar desde cefalea de intensidad variable, síntomas de origen auditivo, tinitus, hipoacusia y vértigo hasta manifestaciones que son clínicamente evidenciables y signos derivados de congestión orbitaria como proptosis, quemosis, soplos orbitarios y pérdida de la visión, causas que motivan un diagnóstico y tratamiento oportuno. Se realiza reporte de un caso de un paciente de 60 años de edad que acude al servicio hospitalario de la Fundación Centro Colombiano y Enfermedades Neurológicas FIRE, con cefalea de 2 meses de evolución, consulta por diplopía binocular, dolor ocular bilateral, inyección conjuntival, secreción purulenta, epifora bilateral, vértigo con miositis orbitaria aguda, fístula carótido-cavernosa en ojo derecho y parálisis del sexto par craneal izquierdo. La panangiografía cerebral reporta fístula carótida-cavernosa indirecta tipo B de Barrow por aferencias del tronco meningohipofisiario derecho e izquierdo por lo que es llevado a terapia endovascular con obliteración exitosa de la fístula.

SUMMARY Carotid-cavernous fistulas are abnormal communications between the internal or external carotid artery or one of its branches (arterial system) and the cavernous sinus (venous system). The spectrum of presentation of this entity is very variable. However, patients may consult for headache and symptoms derived from orbital congestion such as proptosis, chemosis, orbital murmurs and loss of vision. They require timely diagnosis and treatment. We present the case of a 60 year old patient with a history of acute orbital myositis, carotid-cavernous fistula in the right eye, paralysis of the sixth left cranial nerve and a 2 month old headache who consults for binocular diplopia, bilateral ocular pain, conjunctival injection, purulent secretion outflow, bilateral epiphora, sensation of hallucination of movement with gait and photophobia. Cerebral panangiography reports remnant of Barrow's b-type indirect carotid-cavernous fistula by right and left meningohypophysis trunks. The pacient taken to endovascular therapy with successful fistula obliteration.

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.

Importancia del método clínico en el diagnóstico de la fístula carótido-cavernosa / Importance of the clinical method in the diagnosis of the carotid-cavernous fistula

Se describe el caso clínico de un paciente de 49 años de edad, que a causa de una crisis hipertensiva presentó una proptosis con enrojecimiento en el ojo derecho, por lo cual recibió diferentes diagnósticos y tratamientos. Debido a que el paciente no mejoraba y aparecían otras manifestaciones clínicas, fue remitido a las consultas de Glaucoma y Neuroftalmología del Centro Oftalmológico de Santiago de Cuba, donde se le realizaron estudios que condujeron al diagnóstico definitivo de fístula arteriovenosa cavernosa carotídea en el lado derecho, indirecta y de bajo flujo. Se indicó compresión manual externa de la carótida, con lo cual se logró la obliteración de la fístula y la mejoría del afectado

The case report of a 49 years patient that presented a proptosis with right eye reddening due to a hipertensive crisis is described, reason why he received different diagnosis and treatments. As the patient didn't improve and other clinical features appeared, he was referred to the Glaucoma and Neurophthalmology Service of the Ophthalmologic Center in Santiago de Cuba, where some studies were carried out which lead to the definitive diagnosis of indirect and of low flow carotid cavernous arteriovenous fistula in the right side. External manual compression of the carotid was indicated and the obliteration of the fistula and improvement of the affected patient was achieved

Glaucoma secundário a fístula carótido-cavernosa / Secondary glaucoma following carotid cavernous fistula

RESUMO As fístulas carótido-cavernosas são uma causa rara, porém grave, de glaucoma secundário por aumento da pressão venosa episcleral. Apresenta-se um caso de uma mulher de 72 anos, negra, atendida no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (HC-UFTM) com dor, sensação de pulsação, proptose, engurgitamento episcleral e quemose em olho direito, com aumento da pressão intraocular (PIO) apesar do uso de mediação anti-glaucomatosa. Na arteriografia foi evidenciada fístula dural para o seio cavernoso à direita, com refluxo para as veias orbitárias ipsilaterais. Realizou-se tratamento com agente líquido de embolização e, após o tratamento cirúrgico, apresentou melhora completa da proptose e congestão dos vasos episclerais, porém manteve PIO aumentada e desenvolvimento de glaucoma de ângulo fechado pela presença de goniossinéquias em 270º, com controle satisfatório com medicação.

ABSTRACT Carotid-cavernous fistulas are a major cause of secondary glaucoma due to increased episcleral venous pressure. We present the case of a 72-year-old female patient, treated at the Hospital de Clínicas at the Universidade Federal do Triângulo Mineiro (HC-UFTM), with pain, proptosis, episcleral engorgement, chemosis and pulsation in the right eye, with increased intraocular pressure (IOP) on anti-glaucomatous medication.Arteriography showed dural fistula to the right cavernous sinus, with reflux to orbital veins.Treatment with liquid embolization agent was performed, following full recovery of proptosis and congestion of the episcleral vessels. However, the patient maintained increased IOP because of narrow-angle glaucoma development due to the presence of goniosynechiae in 270º, which was controlled satisfactorily with medication.

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.

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.

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.

Transarterial detachable coil embolization combined with ipsilateral intermittent carotid oppression for traumatic carotid-cavernous fistula with small fistula / 中华创伤杂志(英文版)

One case of traumatic carotid-cavernous fistula (TCCF) with small fistula treated by transarterial detachable coil embolization was reported. The intermittent ipsilateral carotid compression was used to identify the final blocking of the residual fistula. The follow-up digital subtraction angiography showed that the TCCF was cured finally. From this case, we conclude that this method may be an effective way to treat TCCF with small fistula.

Factors affecting oculomotor nerve function recovery time following balloon embolization for oculomotor nerve palsy caused by traumatic carotid cavernous sinus fistula / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the factors that affect oculomotor nerve function recovery time in patients receiving balloon embolization for oculomotor nerve palsy caused by traumatic carotid cavernous sinus fistula.</p><p><b>METHODS</b>The clinical data were collected from 87 patients undergoing balloon embolization for oculomotor nerve palsy due to traumatic carotid cavernous sinus fistula from July 2005 to July 2013 and the factors affecting oculomotor nerve function recovery time was analyzed using a self-made questionnaire.</p><p><b>RESULTS AND CONLUSION</b>Oculomotor nerve function recovery time ranged from 1 to 6 months (mean 33.32 ± 16.76 days) in these patients. Age, severity of preoperative oculomotor nerve paralysis, injury-to-treatment time, and number of balloon used were positively correlated with nerve function recovery time, and the flow volume of traumatic carotid cavernous sinus fistula was negatively correlated with the recovery time.</p>

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.

Traumatic Carotid-Cavernous Sinus Fistula in a Patient with Facial Bone Fractures

No abstract available.

Fistulas carótido cavernosa / Carotid Cavernous Fistulas

Las fistulas carotido-cavernosas son patologías vasculares relativamente infrecuentes que tiene una etiología de mayor frecuencia traumática que espontanea. Su diagnóstico no siempre es sencillo y requiere de conocer la patología para poder tener la sospecha clínica y poder brindar solución de manera rápida y minimizar secuelas. El tratamiento de las fistulas ha mejorado con el tiempo y con el advenimiento de la cirugía endovascular, con esto se han ido descubriendo mejores accesos y mecanismos para tratarlo, como lo es el abordaje por la vena oftálmica superior. Sin embargo esto no siempre es posible debido a la variaciones anatómicas que en ella se encuentran, pero cuando se logra tiene resultado cosméticos y funcionales muy adecuados.

Carotid-cavernous fistulas are relatively uncommon vascular pathologies that have a traumatic etiology mostly spontaneous. Diagnosis is not always easy and requires knowledge of pathology to clinical suspicion and have to provide a solution quickly minimizing the consequences. The treatment of the fistulas has improved with the time and with the advent of the surgery endovascular, with this have been discovered and improved access mechanisms as is the boarding across the ophthalmic top vein. Nevertheless, this not always is possible due to the anatomical variations that in her they find, but when it is achieved, there are obtained cosmetic and functional very suitable results.