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DOI: 10.1055/a-1984-1031
A Troublesome Case of Indirect Carotid-Cavernous Fistula Presenting with Proptosis without Pulsation
Präsentation von Koratis-Sinus-Cavernosus-Fisteln mit Proptose ohne Pulsation
Introduction
Carotid-cavernous fistula (CCF) is a rare condition in which an abnormal communication develops between the cavernous sinus (CS) and the carotid arterial system. CCFs are divided into subgroups according to the main cause or anatomical differentiation [1]. CCFs can develop spontaneously or after major head trauma. Shunts between the intracavernous part of the internal carotid artery (ICA) and the CS are called direct fistulas (type A), which are high-flow lesions mostly caused by trauma. Indirect fistulas, on the other hand, present slow-flow lesions and are more likely to occur spontaneously. Their locations are between the meningeal branches of the ICA (type B), external carotid artery (ECA) (type C), or both (type D) and the CS [1], [2].
The main symptoms of proptosis, chemosis, and orbital bruit during auscultation and ophthalmoplegia are due to progressive congestion of the venous sinuses draining into the CS. The severity of the symptoms is determined by the blood flow velocity of the shunts [3], [4]. Hence, direct fistulas can be identified easily while indirect fistulas are frequently misdiagnosed. With the help of cerebral angiography, which is the gold standard diagnostic method for CCFs [5], an accurate diagnosis and treatment plan with endovascular flow converting stents can be achieved in order to improve the clinical findings in appropriate cases [3].
Publication History
Received: 13 October 2022
Accepted: 20 November 2022
Accepted Manuscript online:
22 November 2022
Article published online:
12 January 2023
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