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BMC Ophthalmol 2019 Feb 11;19(1):48. Epub 2019 Feb 11.

Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, No 324, Jingwu Road, Huaiyin Zone, Jinan, Shandong Province, 250012, People's Republic of China.

Background: Painful ophthalmoplegia can be caused by various etiologies, and broad differential diagnosis is needed. Carotid-cavernous fistula (CCF) is a rare cause of painful ophthalmoplegia, and early diagnosis is quite difficult.

Case Presentation: Here, we present a case of paroxysmal painful ophthalmoplegia caused by CCF. Read More

Medicine (Baltimore) 2019 Feb;98(6):e14472

Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan.

Rationale: Isolated third nerve palsy with pupillary involvement caused by a posterior drainage carotid-cavernous sinus fistula (CCF) is relatively rare. Diagnosis of a posterior drainage CCF can often be delayed due to its unapparent congestive signs.

Patient Concerns: Here, we present the case of a young male patient with right-sided CCF, who presented with right-side headache and partial third nerve palsy with pupillary involvement. Read More

Ophthalmologe 2018 Nov 30. Epub 2018 Nov 30.

Klinik und Poliklinik für Augenheilkunde, Klinikum der Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.

Background: Glaucoma due to elevated episcleral venous pressure is a rare and difficult to treat form of secondary open angle glaucoma.

Objective: The pathophysiology, clinical findings, differential diagnosis and treatment options are discussed. Radius-Maumenee syndrome, Sturge-Weber syndrome and carotid-cavernous sinus fistulas are covered in particular. Read More

World Neurosurg 2019 Feb 19;122:495-499. Epub 2018 Nov 19.

Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.

Background: A small number of reports have described subarachnoid hemorrhage resulting from a ruptured aneurysm embedded within a prolactinoma. To the best of our knowledge, no reports have described an embedded carotid cavernous fistula. We report a patient with carotid cavernous fistula secondary to a ruptured internal carotid artery aneurysm embedded within a prolactinoma. Read More

Orbit 2018 Nov 22:1-10. Epub 2018 Nov 22.

a Department of Ophthalmology , Royal Brisbane and Women's Hospital , Herston , Queensland , Australia.

Purpose: The main objective was to report the epidemiology, clinical manifestations, angiography features, treatment modality and post-treatment outcomes in patients diagnosed with carotid cavernous fistulas (CCF).

Methods: A retrospective review of the medical imaging database in conjunction with medical records from 2004 to 2017 at the Royal Brisbane and Women's Hospital (RBWH) was conducted.We identified 39 patients with CCF (16 direct, 23 indirect). Read More

J Trauma Acute Care Surg 2018 Dec;85(6):1131

Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive, Surgery Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, Craniofacial Research Center, Chang Gung University, Taoyuan, Taiwan.

Asian J Neurosurg 2018 Oct-Dec;13(4):1244-1246

Department of Neurosurgery, Lilavati Hospital, Mumbai, Maharashtra, India.

This report documents the occurrence, diagnosis and treatment of a 29 year-old male patient who presented with progressive swelling of the left eye with associated progressive loss of vision, three months after sustaining a closed head injury in a road traffic accident. Magnetic resonance imaging (MRI) showed a large, ill-defined lesion in the left supraclinoid and paraclinoid region with variable contrast enhancement. A four vessel Digital Subtraction Angiography (DSA) showed a large, supra-clinoid pseudoaneurysm which had ruptured inferiorly into the roof of cavernous sinus, forming direct carotid cavernous fistula (CCF) which lead to dilatation of the superior ophthalmic vein and subsequent peri-orbital oedema and chemosis of conjunctiva. Read More

No Shinkei Geka 2018 Nov;46(11):989-997

Department of Neurosurgery, Higashihiroshima Medical Center.

Traumatic carotid cavernous fistula(CCF)is known to present a direct connection between the cavernous segment of the internal carotid artery(ICA)and the cavernous sinus(CS). In rare cases, the fistula is formed between the intradural internal carotid artery(ICA)and the cavernous sinus(CS)via a pseudoaneurysm(pAN), requiring appropriate management and aggressive surgical treatment. We describe a 58-year-old man who sustained a severe head injury diagnosed as traumatic CCF treated with an intradural pAN procedure and transarterial coil embolization combined with a Low-profile Visualized Intraluminal Support(LVIS)stent. Read More

Am J Emerg Med 2019 Feb 7;37(2):378.e7-378.e9. Epub 2018 Nov 7.

Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address:

A ruptured cavernous carotid aneurysm (CCA) with carotid cavernous fistula can appear as a benign headache but progress to a swollen and bloodshot eye overnight. A 66-year-old woman visited emergency department with sudden onset of pain behind her left forehead and vomiting. She was treated for a migraine-like headache and discharged. Read More

Case Rep Oncol Med 2018 15;2018:6025274. Epub 2018 Oct 15.

Department of Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, USA.

Superior ophthalmic vein thrombosis is extremely rare and is often associated with orbital inflammation/infection, systemic/local tumors, hypercoagulable states, autoimmune conditions, and rarely carotid cavernous fistula. Clinical features include abrupt onset of painful proptosis, chemosis, ophthalmoplegia, and diminished visual acuity. Prompt diagnosis and treatment are essential to prevent permanent blindness. Read More

J Trauma Acute Care Surg 2018 Oct 29. Epub 2018 Oct 29.

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung 204, Craniofacial Research Center, Chang Gung University, Taoyuan, Taiwan.

Interv Neuroradiol 2018 Sep 23:1591019918800220. Epub 2018 Sep 23.

3 Department of Radiology, Bumrungrad International Hospital, Bangkok, Thailand.

Spontaneous regression of direct carotid-cavernous fistulas (CCFs) is extremely rare. Most of the patients with direct CCFs are usually treated using endovascular techniques. Spontaneous obliteration of the direct fistulas probably results from thrombosis of the venous drainage and/or cavernous sinus. Read More

J Binocul Vis Ocul Motil 2018 Jan-Mar;68(1):10-19. Epub 2018 Feb 5.

a Department of Ophthalmology , Saint Louis University Medical Center , St. Louis , Missouri.

Ophthalmoplegia or ophthalmoparesis are the terms given to paralysis or paresis of one or more of the extraocular muscles in one or both eyes. It may be representative of serious neurological or systemic disease. Other mechanisms may cause limitation of eye movement, including restrictive or myasthenic conditions, or combinations of several etiologies. Read More

Am J Emerg Med 2018 Dec 21;36(12):2336.e1-2336.e2. Epub 2018 Aug 21.

Department of Ophthalmology, Beijing Aerospace General Hospital, 7 Wanyuan North Road, Fengtai District, Beijing 100076, China. Electronic address:

A 73-year-old woman initially presented to our ophthalmology department with complaint of a red eye with gradual proptosis and mild restricted movement of the right eye who was misdiagnosed with conjunctivitis during 2 months. One week later she returned to the emergency department with a painful, swollen right eye and a high intraocular pressure of 41 mm Hg and limitation of her extraocular muscles in nearly all fields of gaze. As her IOP was high, she was diagnosed as having secondary glaucoma and was prescribed timolol 0. Read More

Interv Neuroradiol 2018 Aug 30:1591019918796493. Epub 2018 Aug 30.

1 Division of Interventional Neuroradiology, University of São Paulo, São Paulo, Brazil.

Introduction Multiple ways to access the dural carotid cavernous fistula have been described. The aim of the present study was to assess the results of embolization of a dural carotid cavernous fistula via different routes using endovascular accesses as a first-line strategy. Methods A retrospective data analysis of a consecutive series of 63 patients presenting with dural carotid cavernous fistula was performed. Read More

BMC Ophthalmol 2018 Jul 25;18(1):183. Epub 2018 Jul 25.

Department of Ophthalmology, The First Affiliated Hospital, Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China.

Background: To report a case of a carotid-cavernous fistula (CCF) that occurred after a motor vehicle accident and review the uniqueness of this case and the main confusing points for the diagnosis of such cases.

Case Presentation: A 22-year-old man complained of left eyelid swelling, eye redness, visual decrease and occasional headache after motor vehicle accident 4 months prior during which he experienced a head injury. He was initially thought to have glaucoma, but he was finally diagnosed with a right CCF based on magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Read More

Neuroophthalmology 2018 Aug 3;42(4):251-255. Epub 2017 Nov 3.

Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan.

A 61-year-old man with hyperthyroidism had exophthalmos with dilated conjunctival vessels in both eyes. Magnetic resonance imaging showed that the superior ophthalmic veins had a funicular-like appearance. Cerebral angiography showed no blood flow from both internal carotid arteries to the cavernous sinus, thus excluding a carotid-cavernous fistula. Read More

Ther Adv Ophthalmol 2018 Jan-Dec;10:2515841418788303. Epub 2018 Jul 17.

North Devon District Hospital, Barnstaple, UK.

Carotid cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus. We present an interesting, rare case of bilateral spontaneous 'Barrow type- C' fistula treated presumptively as conjunctivitis. A 66 year old patient presented in the eye casualty at North Devon District Hospital in January 2016, referred from her General practitioner complaining of bilateral red eyes. Read More

J Emerg Med 2018 09 23;55(3):e75-e76. Epub 2018 Jun 23.

Emergency Department, Mercy Health Partners, Muskegon, Michigan.

Background: A carotid cavernous fistula is a rare type of arteriovenous (AV) fistula due to an abnormal communication between the cavernous sinus and the carotid arterial system. Normal venous return to the cavernous sinus is impeded as high-pressure arterial blood enters the cavernous sinus. The classical triad of symptoms is characterized by pulsating exophthalmos, ocular bruit, and conjunctival chemosis. Read More

Orphanet J Rare Dis 2018 Jun 25;13(1):100. Epub 2018 Jun 25.

Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges Pompidou, AP-HP, 20-40 rue Leblanc, 75908, Paris Cedex 15, France.

Background: Vascular Ehlers-Danlos syndrome (vEDS) is a rare condition characterized by connective tissue fragility. Direct spontaneous carotid-cavernous fistula (sCCF) is reportedly pathognomonic of vEDS. We conducted this study to understand the possible mechanisms of occurrence of sCCF in this subset of patients. Read More

J Radiol Case Rep 2018 Feb 28;12(2):1-10. Epub 2018 Feb 28.

Department of Neurosciences, Royal Brisbane and Women's Hospital, Brisbane, Australia.

Dural arteriovenous fistulas (dAVf) are uncommon, acquired vascular lesions. Their location and vascular anatomy produces varied signs and symptoms and are misdiagnosed as other vascular anomalies. We present an atypical case of a dAVf identified along the left optic nerve sheath. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 Mar;32(3):358-362

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.

Objective: To summarize the injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake.

Methods: The clinical data of 48 patients injured in "8·8" Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). Read More

World Neurosurg 2018 Aug 23;116:152-154. Epub 2018 May 23.

Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China. Electronic address:

Introduction: Persistent trigeminal artery is the most frequent embryonic communication between the vertebrobasilar and carotid systems. To the best of our knowledge, posttraumatic trigeminal-cavernous fistula is rarely reported in the literature.

Case Presentation: We present a 47-year-old man with posttraumatic trigeminal-cavernous fistula, which we treated using Onyx embolization. Read More

Eye (Lond) 2018 10 22;32(10):1676. Epub 2018 May 22.

Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Interv Neuroradiol 2018 Oct 19;24(5):546-558. Epub 2018 May 19.

3 Department of Radiology, Bumrungrad International Hospital, Bangkok, Thailand.

We describe a patient with traumatic carotid-cavernous fistula (CCF), subsequently developing contralateral extensive hemorrhagic venous infarction from retrograde venous reflux into the opposite basal vein of Rosenthal. A 54-year-old woman was involved in a motor vehicle accident and sustained severe traumatic brain injury. Two months later, she developed bilateral proptosis and audible bruit. Read More

Eye (Lond) 2018 10 18;32(10):1675-1680. Epub 2018 May 18.

Leeds Teaching Hospitals NHSFT, Leeds, UK.

Interv Neuroradiol 2018 Oct 12;24(5):567-570. Epub 2018 May 12.

Department of Medical Imaging, Princess Alexandra Hospital, Woolloongabba, Australia.

A healthy 51-year-old female presented with a spontaneous direct carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. She had no history of connective tissue or cerebrovascular disorders or significant head trauma. This is a rare lesion with only 18 previously reported cases. Read More

World Neurosurg 2018 Aug 3;116:e246-e251. Epub 2018 May 3.

Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.

Background: Sixth nerve palsy is a common complication of endovascular treatment for carotid-cavernous fistulas (CCF). Two hypotheses are evoked: the spontaneous venous congestion into the cavernous sinus and the direct compression of the nerve by the embolic agent into the cavernous sinus. Nevertheless, the evidence is still uncertain. Read More

Interv Neurol 2018 Feb 27;7(1-2):1-5. Epub 2017 Sep 27.

Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA.

Post-traumatic carotid-cavernous fistulas are due to a tear in the wall of the cavernous carotid artery, leading to shunting of blood into the cavernous sinus. These are generally high-flow fistula and rarely resolve spontaneously. Most cases require endovascular embolization. Read More

J Neurointerv Surg 2018 Jun 7;10(6):e11. Epub 2018 Apr 7.

Department of Neurosurgery, Huntington Memorial Hospital, Pasadena, California, USA.

Endovascular treatment of carotid cavernous fistulas (CCFs) via a transvenous approach is standard, but in rare cases this approach is challenging due to absence or thrombosis of the commonly used venous routes. A 61-year-old woman presented with a symptomatic CCF with all but one of the venous access routes to the CCF thrombosed, leaving an engorged superficial middle cerebral vein (SMCV) as the only venous outflow from the cavernous sinus. Access to the CCF was made possible after careful navigation of the sigmoid sinus, the vein of Labbé and the SMCV, bypassing the need for surgical access to the SMCV or for a direct transorbital puncture. Read More

Int Ophthalmol Clin 2018 ;58(2):271-294

J Coll Physicians Surg Pak 2018 Mar;28(3):S54-S55

Department of Diagnostic Radiology, Al-Khidmat Teaching Hospital, Mansoora.

A 22-year male presented in outpatient department with right sided proptosis and chemosis, after a roadside accident two months back. He was on treatment for orbital cellulitis and taking steroids with antibiotics, both orally and topically. He was also on topical antiglaucoma agents. Read More

J Trauma Acute Care Surg 2018 Sep;85(3):646

Department of Clinical Epidemiology School of Health (S.S.) Shahid Beheshti University of Medical Sciences Tehran, I.R. Iran.

Surg Neurol Int 2018 16;9. Epub 2018 Jan 16.

Department of Neurological Surgery, University of California Irvine, Orange, California, USA.

Background: Direct, Type A, cavernous-carotid fistulas (CCFs) are predominantly caused by head trauma, especially when basilar skull fractures are present. Transarterial endovascular treatment of direct CCFs is the preferred method of treatment. Bilateral CCFs are estimated to be present in 1-2% of the cases. Read More

BMC Ophthalmol 2018 Feb 2;18(1):25. Epub 2018 Feb 2.

Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand.

Background: Cavernous carotid aneurysm (CCA) represents 2-9% of all intracranial aneurysms and 15% of internal carotid artery (ICA) aneurysms; additionally, giant aneurysms are those aneurysms that are > 25 mm in size. Bilateral CCAs account for 11-29% of patients and are commonly associated with structural weaknesses in the ICA wall, secondary to systemic hypertension. CCAs are considered benign lesions, given the low risk for developing major neurologic morbidities (i. Read More

Medicine (Baltimore) 2017 Dec;96(52):e9511

Department of Pediatrics, West China Second Hospital, Sichuan University.

Rationale: Cavernous sinus-carotid fistula (CCF) is a rare complication of craniofacial injuries in patients receiving oral and maxillofacial surgical care.

Patient Concerns: A retrospective review of 15 patients with CCF records was conducted. In addition, we present a rare case of a 32-year-old Chinese woman with CCF receiving oral and maxillofacial surgical care. Read More

Acta Ophthalmol 2018 Nov 25;96(7):e895-e896. Epub 2018 Jan 25.

Department of Ophtalmology, A. de Rothschild Ophtalmologic Foundation, Paris, France.

Interv Neuroradiol 2018 Apr 25;24(2):210-213. Epub 2018 Jan 25.

2 Bangalore, India.

We report a case of delayed migration of Squid 18 following treatment of a direct carotico-cavernous fistula. Read More

NMC Case Rep J 2018 Jan 28;5(1):15-19. Epub 2017 Nov 28.

Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.

A delayed aneurysm rupture after flow diverter therapy is a rare but serious complication. Due to the anatomical specificity, a delayed rupture of a carotid cavernous aneurysm may cause a direct carotid cavernous fistula (dCCF). We present a novel therapeutic approach for treatment of dCCF after flow diverter therapy using the Pipeline embolization device (PED). Read More

Folia Med (Plovdiv) 2017 Dec;59(4):472-476

2Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.

We describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. Read More

Am J Case Rep 2018 Jan 12;19:47-51. Epub 2018 Jan 12.

Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA.

BACKGROUND Carotid cavernous fistulas (CCFs) are rare potentially sight-threatening abnormal connections between carotid artery and cavernous sinus. CASE REPORT We report a case of CCF in an 83-year-old female, who presented with swollen and painful right eye. The patient was initially treated with empiric antibiotics for suspected peri-orbital cellulitis, as noted clinically and in computed tomography (CT) orbits. Read More

Orbit 2018 Aug 8;37(4):306-308. Epub 2018 Jan 8.

e Radiodiagnostic and Interventional Radiology Department , University Hospital Ramón y Cajal , Madrid , Spain.

A 47-year-old woman was diagnosed with dural carotid cavernous fistula (CCF) in her right eye (RE). Scans of the choroid using Spectralis optic coherence tomography (OCT) demonstrated significant asymmetry in subfoveal choroidal thickness (RE 451 μm, left eye (LE) 367 μm). This asymmetry disappeared after the fistula was embolizated through the ophthalmic artery (RE 341 μm; LE 340 μm). Read More

J Trauma Acute Care Surg 2018 Feb;84(2):312-318

From the Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery (S.M., C.C., P.C.), Department of Neurosurgery(T.L.), Department of Traumatology (S.W.), Department of Diagnostic Radiology(Y.W.), and Department of Plastic and Reconstructive Surgery (C.C.), Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

Background: Traumatic carotid-cavernous sinus fistula (tCCF) is infrequent but with high morbidity if delayed diagnosed or managed. Because of the lack of screening criteria and requirement of advanced and invasive radiological examinations, diagnosis is often delayed or underdiagnosed.

Methods: A matched case-control study with univariate and multivariate analyses was conducted to predict tCCFs. Read More

Medicine (Baltimore) 2017 Dec;96(49):e9096

Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan (R.O.C.).

Rationale: Orbital compartment syndrome (OCS) is a rare occurrence after transvenous embolization of indirect carotid-cavernous fistula (CCF). A lateral canthotomy and cantholysis are the most commonly performed surgical interventions. In our case, as the acute OCS occurred immediately after an uneventful transvenous embolization, an orbital floor orbitectomy was performed. Read More

J Oral Maxillofac Surg 2018 Apr 23;76(4):826-830. Epub 2017 Nov 23.

Consultant, Department of Oral and Maxillo-Facial Surgery, Oxford University Hospitals National Health Service Foundation Trust, Oxford, Oxfordshire, UK.

A traumatic caroticocavernous fistula (CCF) is an acquired, abnormal communication between the internal carotid artery and the cavernous sinus, secondary to trauma. This rare condition can initially be misdiagnosed, because its presentation shares features common to those of facial trauma, which can result in serious complications. We describe a case of bilateral CCF in an adult patient after a road traffic accident. Read More

J Stroke Cerebrovasc Dis 2018 Apr 22;27(4):e65-e69. Epub 2017 Nov 22.

Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan.

The Pipeline embolization device (PED), a type of flow diverter, has become an appealing alternative treatment option for large or giant and wide-necked intracranial aneurysms. Carotid cavernous fistula (CCF) resulting from delayed aneurysmal rupture is a rare complication of PED placement with unknown pathophysiology. Here, we describe a case of CCF resulting from aneurysmal rupture following PED placement, and present the details of treatment by transvenous coil embolization. Read More

Childs Nerv Syst 2018 Mar 23;34(3):577-580. Epub 2017 Nov 23.

Department of Neurosurgery, School of Medicine, University of Sao Paulo, Rua Dr Eneas de Carvalho, Street Eneas de Carvalho, 155, Pinheiros, Sao Paulo, SP, Brazil.

Background: Carotid-cavernous fistula (CCF) is a shunt between the carotid artery and the cavernous sinus. Traumatic CCFs are diagnosed in 0.2% of head traumas being only 4. Read More