Fistula carótido-cavernosa: importancia de su diagnóstico y tratamiento oportunos para prevenir la ceguera / Carotid cavernous fistula: the importance of its opportune diagnosis and treatment to prevent blindness

A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that can cause severe ocular damage. We hereby report two cases of carotid cavernous fistulas. A 69-year-old male with a 2-month history of right eyelid swelling and red eye aggrarated by diplopia, exophthalmus, and limitation of ocular movements one week before consulting. On admisson his visual acuity, in the right eye was good (0.5) and biomicroscopy showed arterialization of conjunctival vessels. All orbital CAT scan showed a dilatation of the superior orbital vein characteristic of carotid cavernous fistula. A balloon balloon tramponade of the fistula was performed too late (after 3 weeks) and the eye went blind. A 39-year-old female consulted for an acute proptosis of the right eye and severe visual loss. Biomicroscopy showed arterialization of the conjunctival vessels and the CAT scan disclosed a dilatation of the superior orbital vein. She was immediately subjected to a neuroradiological fistula closure with recovery of visual acuity to 1.0 (20/20). Our main purpose is to emphasize the importance of the opportune diagnosis and treatment of these fistulas to prevent visual loss and eventual blindness, as occurred in our first patient.

Fístula carótido-cavernosa: importancia de su diagnóstico y tratamiento oportuno para prevenir la ceguera / Carotid cavernous fistula: importance of its diagnosis and opportune treatment to prevent the blindness

Objetivo: Enfatizar la importancia del diagnóstico clínico y del tratamiento oportuno de las fístulas del seno cavernoso que se manifiestan anterógradamente en la órbita. Pacientes y Métodos: Se presentan dos pacientes atendidos en el Servicio de Oftalmología del Hospital Salvador, tratados endovascularmente en el Instituto de Neurocirugía, quienes presentaron una evolución visual muy disímil (uno llegó a la ceguera y el otro recuperó en 100 por ciento de visión) debido a las diferencias en el tiempo de diagnóstico e inicio del tratamiento. Discusión: Se discuten las diferencias en la expresión clínica de los adversos tipos de fístulas (de bajo y alto flujo), el diagnóstico diferencial y la importancia del tratamiento oportuno para lograr un resultado anatómico y funcional óptimo del ojo afectado.