Caroticocavernous Fistulae: Clinical Presentation, Imaging, and Endovascular Treatment

Abstract

Caroticocavernous fistulas (CCFs) occur due to an abnormal communication between the high-pressure carotid artery system and the relatively lower pressure cavernous sinus system. They present with dramatic clinical presentations comprising among other things a swollen red eye with associated loss of vision to a varying degree. Blunt trauma sustained to the head, especially by two-wheeler riders, is the most common cause of the direct CCF and hence a practicing interventional radiologist in a developing country is very likely to encounter this entity in clinical practice. The authors intend to present a pictorial essay of the clinical presentations, imaging findings, endovascular management, and clinical follow-up for CCFs.

Keywords

caroticocavernous fistula - proptosis - embolization

• References

• 1 Ringer AJ, Salud L, Tomsick TA. Carotid cavernous fistulas: anatomy, classification, and treatment. Neurosurg Clin N Am 2005; 16 (02) 279-295
• 2 Tjoumakaris SI, Jabbour PM, Rosenwasser RH. Neuroendovascular management of carotid cavernous fistulae. Neurosurg Clin N Am 2009; 20 (04) 447-452
• 3 Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985; 62 (02) 248-256
• 4 Ernst RJ, Tomsick TA. Classification and angiography of carotid cavernous fistulas.. In: Tomsick TA. ed. Carotid cavernous sinus fistula. Cincinnati, OH: Digital Education Publishing; 1997: 13-22
• 5 Connors JJ, Wojak JC. Interventional Neuroradiology: Strategies and Practical Techniques. Philadelphia, PA: WB Saunders Co; 1999: 215-226
• 6 Raskind R, Johnson N, Hance D. Carotid cavernous fistula in pregnancy. Angiology 1977; 28 (10) 671-676
• 7 Brismar G, Brismar J. Spontaneous carotid-cavernous fistulas: phlebographic appearance and relation to thrombosis. Acta Radiol Diagn (Stockh) 1976; 17 (02) 180-192
• 8 Toya S, Shiobara R, Izumi J, Shinomiya Y, Shiga H, Kimura C. Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage. Report of two cases. J Neurosurg 1981; 54 (02) 252-256
• 9 Kwan E, Hieshima GB, Higashida RT, Halbach VV, Wolpert SM. Interventional neuroradiology in neuro-ophthalmology. J Clin Neuroophthalmol 1989; 9 (02) 83-97
• 10 Debrun GM. Treatment of traumatic carotid-cavernous fistula using detachable balloon catheters. AJNR Am J Neuroradiol 1983; 4 (03) 355-356
• 11 Tomsick TA. Types B, C, and D (dural) CCF: etiology, prevalence, and natural history. In: Carotid Cavernous Fistula. Cincinnati, OH: Digital Educational Publishing; 1997: 59-73
• 12 Yu SC, Cheng HK, Wong GK, Chan CM, Cheung JY, Poon WS. Transvenous embolization of dural carotid-cavernous fistulae with transfacial catheterization through the superior ophthalmic vein. Neurosurgery 2007; 60 (06) 1032-1037
• 13 Tomsick TA. Type B, C, and D (dural) CCF: etiology, prevalence and natural history.. In: Tomsick TA. editor. Carotid Cavernous Sinus Fistula. Cincinnati, OH: Digital Education Publishing; 1997: 59-73
• 14 Halbach VV, Hieshima GB, Higashida RT, Reicher M. Carotid cavernous fistulae: indications for urgent treatment. AJR Am J Roentgenol 1987; 149 (03) 587-593
• 15 Gemmete JJ, Ansari SA, Gandhi DM. Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol 2009; 29 (01) 62-71
• 16 Meyers PM, Halbach VV, Dowd CF. et al. Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up. Am J Ophthalmol 2002; 134 (01) 85-92
• 17 McConnell EM. The arterial blood supply of the human hypophysis cerebri. Anat Rec 1953; 115 (02) 175-203
• 18 Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid cavernous sinus fistula: a systematic review. World J Radiol 2013; 5 (04) 143-155
• 19 Rajagopal R, Mehta N, Saran S, Khera PS. Heuber maneuver in evaluation of direct carotid-cavernous fistula. Pol J Radiol 2016; 81: 483-485
• 20 Pollock BE, Nichols DA, Garrity JA, Gorman DA, Stafford SL. Stereotactic radiosurgery and particulate embolization for cavernous sinus dural arteriovenous fistulae. Neurosurgery 1999; 45 (03) 459-466
• 21 Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 1974; 41 (02) 125-145
• 22 Sencer S, Minareci O, Poyanli A. Management of a rare complication of endovascular treatment of direct carotid cavernous fistula. AJNR Am J Neuroradiol 1999; 20 (08) 1465-1466
• 23 Klisch J, Schipper J, Husstedt H, Laszig R, Schumacher M. Transsphenoidal computer-navigation-assisted deflation of a balloon after endovascular occlusion of a direct carotid cavernous sinus fistula. AJNR Am J Neuroradiol 2001; 22 (03) 537-540
• 24 Halbach VV, Higashida RT, Hieshima GB, Reicher M, Norman D, Newton TH. Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology 1987; 163 (02) 437-442
• 25 Higashida RT, Halbach VV, Tsai FY. et al. Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases. AJR Am J Roentgenol 1989; 153 (03) 577-582
• 26 Gupta AK, Purkayastha S, Krishnamoorthy T. et al. Endovascular treatment of direct carotid cavernous fistulae: a pictorial review. Neuroradiology 2006; 48 (11) 831-839