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Clin Imaging 2020 Jun 18;68:71-89. Epub 2020 Jun 18.

NYU Langone Health, Department of Radiology, New York, NY, United States of America. Electronic address:

The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Read More

Neurointervention 2020 Jul 19;15(2):96-100. Epub 2020 Jun 19.

Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India.

Direct carotid-cavernous fistula (CCF) refers to direct communication between the cavernous portion of the internal carotid artery (ICA) and the cavernous sinus due to rent in the ICA, most commonly secondary to trauma. These are generally high-flow fistula and rarely resolve spontaneously. We report a case of a young male who developed features of direct CCF after trauma, was denied any treatment for 4 years, and then presented with spontaneous thrombosis of the fistula and a residual large pseudoaneurysm of the cavernous segment of the right ICA, which was subsequently managed with parent vessel occlusion. Read More

J Vis Exp 2020 May 21(159). Epub 2020 May 21.

Brain Center, Zhejiang Hospital;

Carotid cavernous fistula (CCF) is a rare disease caused by abnormal communications between the internal carotid artery (direct fistula) or meningeal branches of the external carotid artery (indirect fistula) and the cavernous sinus (CS). Trauma is the most common cause of CCF. The clinical presentation of CCF is closely related to the venous drainage pattern. Read More

Radiol Case Rep 2020 Jul 23;15(7):1103-1109. Epub 2020 May 23.

Moscow Regional Research and Clinical Institute Named After M.F. Vladimirskiy, Shepkina str., 61/2, Moscow 129110, Russian Federation.

Carotid-cavernous fistula (CCF) is a pathologic communication between carotid arteries and cavernous sinus. The goal of endovascular treatment is to completely interrupt the carotid-cavernous communication with preserving normal blood flow in carotid arteries. Embolization can be performed via transarterial or transvenous access depending on anatomy and angioarchitecture of fistula. Read More

Clin Neuroradiol 2020 May 30. Epub 2020 May 30.

Institute for diagnostic and interventional Radiology and Neuroradiology, Helios HSK Wiesbaden, Wiesbaden, Germany.

World Neurosurg 2020 May 11;140:18-25. Epub 2020 May 11.

Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Background: Carotid-cavernous fistulas (CCFs) are abnormal communications between the arterial and venous circulation within the cavernous sinus, manifesting in myriad neurological and ophthalmological sequalae. In rare circumstances patients' unique vascular anatomies preclude standard endovascular treatment for this pathology, warranting combined surgical and endovascular approaches wherein the cavernous sinus is accessed via superior ophthalmic vein (SOV) exposure, cutdown, and cannulation.

Case Description: We describe 3 cases of CCF treated at our quaternary neurovascular referral center between 2017 and 2019. Read More

Clin Neurol Neurosurg 2020 May 4;195:105882. Epub 2020 May 4.

Department of Interventional Neuroradiology, Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address:

Cureus 2020 Apr 3;12(4):e7524. Epub 2020 Apr 3.

Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.

A carotid-cavernous fistula (CCF) is an abnormal connection between the arteries and veins of the cavernous sinus. Iatrogenic CCFs have been described as potential complications following aneurysm coiling, balloon angioplasty, and transsphenoidal surgery. In this case report, we describe a rare case of an iatrogenic direct CCF following mechanical thrombectomy (MT) for acute ischemic stroke. Read More

Medicina (Kaunas) 2020 Apr 23;56(4). Epub 2020 Apr 23.

Faculty of Technical Sciences, University of Novi Sad, TrgDositejaObradovića 6, 21000 Novi Sad, Serbia.

Spontaneous carotid-cavernous fistulas (CCFs) are rare, and they may be caused by an aneurysm rupture. A case of a man hospitalized for high-intensity hemicranial headache with sudden cough onset as part of an upper respiratory tract infection is presented. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. Read More

J Clin Neurosci 2020 Apr 21. Epub 2020 Apr 21.

Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, United States. Electronic address:

A carotid-cavernous fistula (CCF) is an abnormal connection between the carotid circulation and the cavernous sinus. Treatment of CCFs often consists of obliteration of the fistula by a transarterial or transvenous endovascular approach using embolic agents. However, fistula embolization is often halted due to the potential embolic complications that may arise from the retrograde flow of the embolic agents into the arterial circulation, which often leads to the development of fistula recurrence. Read More

Stroke 2020 Jun 16;51(6):e107-e110. Epub 2020 Apr 16.

From the Department of Neurology (T.J.P., C.S., R.M., J.S.), Yale School of Medicine, New Haven, CT.

Acta Neurol Taiwan 2020 Mar;29(1):18-23

Department of Neurology, China Medical University Hospital, Taichung, Taiwan.

Background: Failure to recognize a carotid-cavernous fistula (CCF) promptly may lead to worse prognosis due to a setback in providing proper treatment. To promote early diagnosis of non-traumatic CCF, we report a case with classic clinical symptoms and signs that was diagnosed and followed up with carotid Doppler sonography (CDS) and transcranial color-coded duplex (TCD).

Case Report: A 45-year-old woman developed an intermittent headache, pulsatile tinnitus, and double vision sequentially within ten days. Read More

Pan Afr Med J 2019 18;34:204. Epub 2019 Dec 18.

Department of Ophthalmology, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.

Posttraumatic carotid-cavernous fistula (CCF) is a very rare complication that can occur in patients with craniomaxillofacial trauma. It is defined by abnormal communication between arteries and veins located in the cavernous sinus. CCFs can be divided into two groups: direct, which are usually post traumatic and classically with a high flow and acute onset of symptoms. Read More

World Neurosurg 2020 03;135:397-398

Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address:

Acta Neurol Taiwan 2019 Sep;28(3):75-77

Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan.

Carotid-cavernous fistulae (CCFs) are classified into the direct and indirect types, which can be attributed to trauma, atherosclerosis, hypertension, diabetes mellitus, pregnant or postmenopausal status(1). Cerebral angiography is the gold standard for the diagnosis of CCFs. Doppler ultrasound, which typically reveals increased blood flow velocity and decreased resistance index (RI) in the feeding arteries, can assist in the diagnosis(2-3). Read More

J Headache Pain 2020 Jan 16;21(1). Epub 2020 Jan 16.

Clinica Neurologica, Dipartimento di Neuroscienze, Policlinico Gemelli, Università Cattolica, Rome, Italy.

Background: Dural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. Clinical course varies widely and ranges from benign with spontaneous remission to fatal, due to cerebral hemorrhage. In a 10-year single institution experience, clinical presentation of dural arteriovenous fistulas, and in particular headache and angiographic features, as well as long-term outcome were analyzed. Read More

Oper Neurosurg (Hagerstown) 2020 Jan 14. Epub 2020 Jan 14.

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

Background And Importance: Carotid-cavernous fistulas (CCF) are pathological connections between carotid artery branches and the cavernous sinus. They can lead to a variety of symptoms, such as chemosis and double vision, or more insidious events, such as vision loss and intracranial hemorrhage. Although these patients are often treated by endovascular means, we describe a case in which the patient's CCF was not able to be accessed by usual methods and required an open surgical approach. Read More

Childs Nerv Syst 2020 02 4;36(2):251-262. Epub 2020 Jan 4.

Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.

Introduction: Posttraumatic craniocervical vascular injuries in pediatric traumatic brain injury (TBI) are rare, and children-specific, evidence-based standards on screening and therapy of posttraumatic carotid-cavernous fistula (CCF), craniocervical artery dissections (CCAD), traumatic aneurysms (TA), and posttraumatic sinus venous thrombosis (SVT) is lacking. The aim of this review is to summarize the data on epidemiology, clinical presentation, and treatment of these traumatic lesions in a systematic manner.

Methods: We performed a systematic PubMed search for records of CCF, CCAD, TA, and SVT related to pediatric TBI published until June 2019. Read More

J Cerebrovasc Endovasc Neurosurg 2019 Jun 30;21(2):101-106. Epub 2019 Jun 30.

Department of Neurosurgery, Eulji University Eulji Hospital, Seoul, Korea.

We describe a case of transvenous embolization through the dilated supraorbital vein to treat a dural carotid cavernous fistula. The approach through the common facial vein or direct access of the superior ophthalmic vein is a commonly used route to the superior ophthalmic vein when the approach via the inferior petrosal sinus is unavailable. In rare cases, the dilated supraorbital vein provides an alternative route and we discuss the technical details. Read More

Neurosurgery 2020 02;86(2):E227-E228

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.

Medicine (Baltimore) 2019 Nov;98(48):e18184

Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China.

Rationale: Dual aneurysms arising from the internal cerotic artery (ICA) is a very rare occurrence. Clinoid segment aneurysms (CSAs) are often seen at the carotid dural rings while cavernous carotid aneurysms (CCAs) are often a direct communication between the ICA and the cavernous sinus (CS). We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) PATIENT CONCERNS:: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Read More

Radiol Case Rep 2019 Dec 31;14(12):1554-1557. Epub 2019 Oct 31.

Department of Interventional Neuroradiology, Bellvitge University Hospital, C/Feixa Llarga s/n 08017. Hospitalet de Llobregat, Barcelona, Spain.

Direct carotid-cavernous fistula is a communication between the internal carotid artery and the cavernous sinus, most of the times established following trauma or rupture of a cavernous aneurysm. The most commonly used treatments (coils, detachable latex balloons, stents, or liquid agents) carry ischemic or hemorrhagic risks, related to hemodynamic diversion of cerebral blood flow or permanent dual antiplatelet therapy. We report a case of coiling of a carotid-cavernous fistula assisted by the Comaneci, a temporary adjustable bridging mesh (Rapid Medical, Israel), to avoid transarterial or -venous migration. Read More

BMJ Case Rep 2019 Nov 10;12(11). Epub 2019 Nov 10.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada

A 59-year-old man presented with a 2-week history of binocular horizontal diplopia worse when looking to the left. He was diagnosed with a left sixth nerve palsy (6 NP) and had new bilateral findings at a 2-week follow-up with new dilated episcleral blood vessels. Bilateral carotid-cavernous fistulas (CCFs) were suspected and confirmed with CT angiography and catheter angiography. Read More

World Neurosurg 2020 Feb 8;134:221-227. Epub 2019 Nov 8.

Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.

Background: Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery.

Methods: The aim of this article is to report a case of CCF after the endoscopic resection of a growth hormone secreting pituitary microadenoma, and to discuss and review all the cases of CCF secondary to transsphenoidal procedures described in literature.

Results: A patient aged 74 years was operated for a growth hormone pituitary microadenoma through an endoscopic transsphenoidal surgery. Read More

World Neurosurg 2020 Feb 31;134:211-214. Epub 2019 Oct 31.

Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Read More

No Shinkei Geka 2019 Oct;47(10):1065-1072

Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center.

We herein report a case of direct carotid-cavernous fistula(direct CCF)in a patient with masked hypertension caused by bilateral subclavian artery stenosis. A 74-year-old woman presented with headache, right-sided proptosis, double vision, and pulsatile tinnitus since past 10 days. The patient was diagnosed with direct CCF. Read More

J Glaucoma 2019 12;28(12):1074-1078

Department of Orbit Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya Medical Research Foundation.

Precis: Secondary ocular hypertension (OHT) is common in carotid-cavernous fistulas (CCFs). Management of elevated intraocular pressure (IOP) is possible with a multidisciplinary approach. The ipsilateral normal eyes may have higher IOP than the contralateral eyes. Read More

Eur J Radiol Open 2019 11;6:258-264. Epub 2019 Jul 11.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building, 60 Fenwood Road, Boston, MA 02115, USA.

Purpose: Superior ophthalmic vein thrombosis (SOVT) is an extremely rare condition. Few studies have been published about clinical aspects of this condition. In this study, we have studied the symptoms, underlying etiologies, treatment, pathogenesis and complication of the SOVT and we tried to classify it based on the etiology, treatment, and prognosis. Read More

PLoS One 2019 17;14(10):e0223488. Epub 2019 Oct 17.

Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany.

Purpose: Endovascular embolization nowadays is a well-established treatment option for direct carotid cavernous fistulas (dCCF, Barrow Type A). There are many publications on the complication and success rates of this method. However, little is known on the patients´ opinion on the treatment result after several years. Read More

World Neurosurg 2020 Jan 9;133:e796-e803. Epub 2019 Oct 9.

Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA.

Background: Techniques for endovascular management of carotid-cavernous fistulas (CCFs) have evolved over the years. Current strategies include transarterial or transvenous approaches and direct puncture or exposure of the cavernous sinus. Rarely, complex CCFs may require multiple approaches or procedures. Read More

J Neurosurg 2019 Sep 27:1-8. Epub 2019 Sep 27.

1Section of Neurosurgery, Department of Surgery, and.

In 1950, Dwight Parkinson was the first qualified neurosurgeon to arrive in Winnipeg, Manitoba. He played a monumental role in developing one of the earliest neurosurgical training programs in Western Canada. Parkinson was a pioneering neurosurgeon who served as the first president of the Canadian Neurosurgical Society in 1965. Read More

World Neurosurg 2020 Jan 18;133:e479-e486. Epub 2019 Sep 18.

Department of Neurosurgery, North-Shore Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA; Department of Radiology, North-Shore Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA.

Background: Cavernous carotid fistulas (CCF) are anatomically complex vascular lesions. Treatment via the venous approach has been previously described and is highly dependent on the patency of the drainage pathways. The use of a unilateral approach to contralateral or bilateral shunts is technically challenging and not commonly described. Read More

Tunis Med 2019 Jan;97(1):145-148

Purpose: to report a case of a woman who had a severe cranial trauma complicated by two ophalmologic potentially cecitating complications: right carotido-cavernous fistula and left traumatic optic neuropathy.

Observation: A 56 years-old woman, without any medical history, referred, one month after fall from a height of 3 meters, for right exophthalmos. Ophthalmic examination of the right eye completed by retinal angiography suspected carotid-cavernous fistula which was confirmed by angio-MRI. Read More

BMJ Case Rep 2019 Sep 16;12(9). Epub 2019 Sep 16.

Ophthalmology, Vancouver General Hospital, Vancouver, British Columbia, Canada.

A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Read More

Interv Neuroradiol 2020 Feb 26;26(1):90-98. Epub 2019 Aug 26.

Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China.

Objective: The purpose of the study was to investigate the treatments and outcomes of patients with traumatic carotid-cavernous sinus fistula (TCCF).

Methods: All patients diagnosed with TCCF at our institution from January 2013 to December 2018 and meeting the inclusion/exclusion criteria were included in the study.

Results: A total of 24 patients were included in this study. Read More

J Stroke Cerebrovasc Dis 2019 Nov 19;28(11):104306. Epub 2019 Aug 19.

Department of Neurosurgery, Department of Interventional Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Carotid-Cavernous sinus fistula (CCF) caused by a ruptured aneurysm of persistent primitive trigeminal artery (PPTA) is exceptionally rare. Herein, we reported the case of a 64-year-old female who presented with headache, pulsatile tinnitus, and diplopia. Angiography showed a PPTA and CCF. Read More

World Neurosurg 2019 Nov 14;131:196. Epub 2019 Aug 14.

Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Carotid-cavernous fistulas are vascular malformations that pose a risk for intracranial hemorrhage when there is documented cortical venous drainage. When possible, treatment with transvenous embolization has become the technique of choice since the late 1990s. We present a case of a patient with a carotid-cavernous fistula treated with venous coil embolization via a jugular venous approach. Read More

World Neurosurg 2020 Jan 14;133:409-412. Epub 2019 Aug 14.

Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran; Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Carotid cavernous aneurysm (CCA) rupture is rare. However, it can result in various complications such as carotid cavernous fistula (CCF), epistaxis, spontaneous thrombosis, and subarachnoid hemorrhage.

Case Description: We report a 65-year-old woman with a history of uncontrolled diabetes who was referred with complaints of acute headache, diplopia, proptosis, and chemosis. Read More

Clin Pract Cases Emerg Med 2019 Aug 29;3(3):256-258. Epub 2019 May 29.

University of Chicago, Department of Emergency Medicine, Chicago, Illinois.

A 63-year-old female presented to the emergency department with worsening left-sided blurry vision and diplopia. She had previously seen several physicians and had been diagnosed with common ocular conditions - keratoconus and dry eye. However, despite treatment her symptoms were worsening. Read More

AJNR Am J Neuroradiol 2019 09 8;40(9):1498-1504. Epub 2019 Aug 8.

From the Departments of Radiology and Nuclear Medicine (M.M., S.A.H.P., M.P., R.M., F.J.A.M.).

Background And Purpose: 4D CT angiography is increasingly used in clinical practice for the assessment of different neurovascular disorders. Optimized processing of 4D-CTA is crucial for diagnostic interpretation because of the large amount of data that is generated. A color-mapping method for 4D-CTA is presented for improved and enhanced visualization of the cerebral vasculature hemodynamics. Read More

Proc (Bayl Univ Med Cent) 2019 Jul 24;32(3):382-384. Epub 2019 May 24.

Department of Ophthalmology & Visual Sciences, University of Texas Medical BranchGalvestonTexas.

This case report highlights utilization of image-guided, percutaneous transorbital direct cavernous sinus puncture to embolize an anteriorly draining carotid cavernous fistula (CCF) when conventional transarterial and transvenous approaches were not feasible. An 86-year-old man with a known posterior draining CCF developed acute unilateral proptosis, pain, and vision loss ("red-eyed shunt"). Cerebral angiogram revealed the dural CCF to be draining anteriorly into partially thrombosed ophthalmic veins. Read More

Ann Vasc Surg 2019 Nov 2;61:203-211. Epub 2019 Aug 2.

Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address:

Background: Willis covered stents are used in clinical practice for some complex cerebrovascular diseases. However, the performance of the Willis covered stent requires further investigation. In this study, we investigate the safety and efficacy of Willis covered stents for the treatment of complex vascular diseases of the internal carotid artery (ICA). Read More

Neurocirugia (Astur) 2020 Mar - Apr;31(2):98-102. Epub 2019 Jul 31.

Departamento de Microneurocirugía, Instituto Nacional de Ciencias Neurológicas, Lima, Perú.

A 50-year-old male patient who, after 3 months of cranial brain trauma, presented proptosis, chemosis and exophthalmos in the left eye. Subsequently, dysmetria develops in the left extremities and right hemiparesis. The diagnosis of carotid-cavernous fistula (FCC) associated with hyperintensity of signal in FLAIR and diffuse contrast uptake at the level of the pseudo tumoral protuberance and cerebellar peduncle was established. Read More

GMS Ophthalmol Cases 2019 16;9:Doc28. Epub 2019 Jul 16.

Sohag Faculty of Medicine, Ophthalmology Department, Sohag, Egypt.

In this report, we are presenting a case of a 49-year-old female complaining of defective vision in the left eye. The main complaints were: pain, redness, mild proptosis, and high intraocular pressure. She had a history of uneventful phacoemulsification surgery 3 months prior to presenting to us. Read More

J Neurointerv Surg 2019 11 2;11(11):1129-1134. Epub 2019 Jul 2.

Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.

Background: Direct carotid-cavernous sinus fistulas (dCCFs) are high flow arteriovenous shunts between the internal carotid artery and the cavernous sinus. Recently, we have used the pipeline embolization device (PED) to treat dCCFs.

Methods: We describe our experience treating patients with dCCFs in whom the PED was placed as the primary treatment modality. Read More

Am J Ophthalmol 2019 10 19;206:264-273. Epub 2019 Jun 19.

Division of Interventional Neuroradiology, Department of Radiology, Hacettepe University, Ankara, Turkey.

Purpose: To define the retinal and choroidal imaging findings of carotid cavernous fistula (CCF) including central foveal thickness, subfoveal choroidal thickness, choroidal vascularity index (CVI) parameters, and tortuosity indexes (TIs) as compared to a control group (CG).

Design: Cross-sectional study.

Materials And Methods: The spectral domain enhanced-depth imaging optical coherence tomography images of 19 eyes of 19 consecutive patients with angiographically proven CCF and 19 eyes of 19 age- and sex-matched healthy control subjects were included. Read More

Arch Soc Esp Oftalmol 2019 Aug 5;94(8):400-404. Epub 2019 Jun 5.

Instituto de Oftalmología, Fundación de Asistencia Privada Conde de Valenciana IAP, Ciudad de México, México.

The case concerns a 73 year-old female with a diagnosis of hyperthyroidism of 8 months onset. Since then, she has suffered hyperaemia and ocular proptosis. Bilateral exophthalmos was observed in the physical examination, along with mild conjunctival hyperaemia in the right eye associated with dilated episcleral vessels. Read More

Medicine (Baltimore) 2019 May;98(22):e15803

Department of Neurosurgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.

Rationale: Barrow type B carotid-cavernous fistulas are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus; these types of dural fistulas can produce specific patterns of symptoms based on the pattern of venous drainage.

Patient Concerns And Diagnoses: A 67-year-old man came to our hospital presenting with acute left orbital pain and double vision in the left eye. The diagnosis was carotid-cavernous fistula fed by the meningohypophyseal trunk and drained to the left superior ophthalmic vein. Read More

BJR Case Rep 2019 Feb 8;5(1):20180028. Epub 2018 Sep 8.

Department of Radiology, University of Texas Medical Branch , Galveston, TX.

Isolated fourth cranial (trochlear) nerve palsy is an uncommon occulomotor nerve palsy typically secondary to ischemia, inflammation/infection, or mass effect. Due to its positioning within the cavernous sinus, pathology of the deep cerebral venous system would theoretically predispose to palsy of this nerve. We present a case of a patient presenting with isolated trochlear nerve palsy in the setting of angiographically-confirmed direct carotid-cavernous fistula. Read More

World Neurosurg 2019 Aug 23;128:360-364. Epub 2019 May 23.

Department of Neurosurgery, Aichi Medical University, Aichi, Japan.

Background: Persistent primitive trigeminal artery (PPTA) is the most common type of fetal carotid-basilar persisting communication in adulthood; however, carotid-cavernous fistulas (CCFs) associated with PPTA are rare.

Case Description: An 84-year-old woman presented with traumatic CCF associated with PPTA manifesting as vascular bruit. Transarterial embolization was performed. Read More