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World Neurosurg 2022 Jun 21. Epub 2022 Jun 21.

Division of neurosurgery, Department of surgery, Faculty of medicine, Thammasat University Hospital, Pathum Thani, 12120, Thailand.

Background: Endovascular therapy is the first-line treatment for the cavernous sinus dural arteriovenous fistulas (CS-DAVF), particularly transvenous embolization. This study aimed to assess the trans-superior ophthalmic vein approach to embolization for its safety, efficacy, and viability as a first-line treatment in selected patients, with a description of the microsurgical and endovascular techniques.

Methods: We retrospectively reviewed patients with CS-DAVF treated using the direct SOV approach with n-butyl cyanoacrylate (n-BCA) and coils as the main embolic materials from 2015 to 2021. Read More

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096221094181

University of Arkansas for Medical Sciences, Little Rock, USA.

Carotid-cavernous fistula (CCF) is an aberrant communication between the main trunk or branches of carotid artery and the cavernous sinus. Most of the cases of CCF occur following head trauma, but congenital and spontaneous cases have been reported. We report an interesting case of bilateral CCF with no history of trauma, thus most likely spontaneous form. Read More

Radiologie (Heidelb) 2022 Jun 23. Epub 2022 Jun 23.

Klinik für Neuroradiologie, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland.

Clinical Issue: The cerebral dural arteriovenous (AV) fistula is a rare cerebral vascular malformation. Clinical presentation varies from asymptomatic to acute intracranial bleeding. Classification is based on the venous drainage with a risk assessment of bleeding. Read More

J Neurosurg Case Lessons 2022 Jun 20;3(25):CASE22115. Epub 2022 Jun 20.

Departments of Neurosurgery and.

Background: Failure to reach the cavernous sinus after multiple transvenous attempts, although rare, can be challenging for neurointerventionists. The authors sought to demonstrate technical considerations and nuances of the independent performance of a novel hybrid surgical and endovascular transpalpebral approach through the superior ophthalmic vein (SOV) for direct coil embolization of an indirect carotid cavernous fistula (CCF), and they review salient literature regarding the transpalpebral approach.

Observations: An illustrative case, including patient history and presentation, was reviewed. Read More

Front Surg 2022 10;9:895233. Epub 2022 May 10.

Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.

Background: Injury to the internal carotid artery (ICA) during endoscopic transsphenoidal surgery (ETSS) is a serious complication with a risk of mortality. ICA injury during ETSS usually occurs during intrasellar manipulations and rarely occurs in the extrasellar portion. Several hemostatic procedures have been proposed for ICA injury in the intrasellar portion, whereas hemostatic methods for ICA injury in the extrasellar portion, where the ICA is surrounded by bone structures, are less well known. Read More

Neuroophthalmology 2022 11;46(3):199-202. Epub 2021 Nov 11.

Ophthalmology Department, University of Colorado School of Medicine, Aurora, Colorado, USA.

We report a 64-year-old male patient without any contributory medical history who visited the eye clinic due to right-sided headache for 1 month and then loss of vision for 3 days. The clinical presentation suggested a cavernous sinus syndrome and acute optic nerve ischaemia in his right eye. The left eye was normal. Read More

Acta Radiol 2022 May 9:2841851221097462. Epub 2022 May 9.

Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.

Background: A non-invasive, reliable imaging modality that characterizes cavernous sinus dural arteriovenous fistula (CSDAVF) is beneficial for diagnosis and to assess resolution on follow-up.

Purpose: To assess the utility of 3D time-of-flight (TOF) and silent magnetic resonance angiography (MRA) for evaluation of CSDAVF from an endovascular perspective.

Material And Methods: This prospective study included 37 patients with CSDAVF, who were subjected to digital subtraction angiography (DSA) and 3-T MR imaging with 3D TOF and silent MRA. Read More

Zhonghua Kou Qiang Yi Xue Za Zhi 2022 May;57(5):503-508

Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.

To summarize the preliminary efficacy, perioperative management and complications of Le Fort Ⅲ osteotomy and midface distraction in patients with syndromic craniosynostosis by retrospective analysis, and to provide clinical experience for reference. From October 2017 to January 2020, 20 patients with syndromic craniosynostosis underwent Le Fort Ⅲ osteotomy and distraction in The Department of Oral and Maxillofacial Surgery of Peking University International Hospital, including 11 males and 9 females, were involved. The median age was 7 years (1. Read More

Ophthalmologe 2022 May 26;119(5):533-546. Epub 2022 Apr 26.

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

Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure (IOP). In contrast to primary open-angle glaucoma in many cases besides IOP reduction a causal treatment is possible. This article is the second part of a review of the more frequently encountered forms of secondary open-angle glaucoma. Read More

Medicine (Baltimore) 2022 Mar 11;101(10):e29057. Epub 2022 Mar 11.

Department of Neurology, Chonnam National University Medical School & Hospital, Gwangju, South Korea.

Rationale: Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition that commonly arises from infections, including paranasal sinusitis, otitis media, and skin infection. Meanwhile, head trauma as a predisposing factor of SCST has been scarcely reported. We report a case of SCST complicated by meningitis after minor head trauma, even in the absence of identifiable fractures. Read More

Neurologist 2022 Apr 18. Epub 2022 Apr 18.

Department of Neurology, National Neuroscience Institute, Duke-NUS Medical School.

Introduction: The approach to oculomotor nerve palsies involves the exclusion of compressive, infective, inflammatory, or ischemic lesions. Dural arteriovenous fistulae, including carotid-cavernous fistulae (CCF), are known causes of third nerve palsy. However, diagnosis can sometimes be delayed or missed due to the various clinical presentations. Read More

Case Rep Ophthalmol 2022 Jan-Apr;13(1):37-43. Epub 2022 Feb 7.

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

The combination of ipsilateral sixth nerve palsy (6NP) and Horner's syndrome (Horner's) is a localizing sign of an injury to the posterior cavernous sinus. The presentation and clinical course of 3 patients presenting with coexisting ipsilateral 6NP and Horner's as a result of carotid cavernous sinus fistulas (CCFs) are discussed in this case series. We highlight these cases to show the possible sequence of events: (i) simultaneous discovery of 6NP and Horner's, (ii) 6NP followed by Horner's, and (iii) Horner's followed by 6NP. Read More

Surg Neurol Int 2022 29;13:34. Epub 2022 Jan 29.

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

Background: Endovascular treatment may be challenging for cavernous sinus dural arteriovenous fistulas (CSDAVFs) with prominent leptomeningeal drainage without other accessible routes. We report a case of CSDAVF with isolated cortical venous successfully drainage treated by percutaneous transvenous embolization through the vein of Trolard and superficial middle cerebral vein (SMCV). We also review the literature of CSDAVFs treated by transvenous embolization through SMCV with or without combined surgical approach. Read More

BMJ Case Rep 2022 Feb 24;15(2). Epub 2022 Feb 24.

Department of Ophthalmology, AIIMS Rishikesh, Rishikesh, India.

Diagnostics (Basel) 2022 Feb 18;12(2). Epub 2022 Feb 18.

Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.

Carotid cavernous fistulas (CCFs) are abnormal connections between the cavernous sinus and the internal and/or external carotid artery. Endovascular therapy is the gold standard treatment. In the current retrospective single-center study we report detailed dosimetrics of all patients with CCFs treated by endovascular coil embolization between January 2012 and August 2021. Read More

BMJ Case Rep 2022 Feb 9;15(2). Epub 2022 Feb 9.

Department of Neurology, G S Neuroscience Clinic and Research Center, Patna, Bihar, India.

A male in his early teens presented with redness of the right eye following a fall. This redness was progressive and increased suddenly over the week prior to presentation. Fundus evaluation revealed an exudative retinal detachment, and a bruit was audible over the right eye. Read More

NMC Case Rep J 2021 16;8(1):691-696. Epub 2021 Oct 16.

Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan.

Carotid-cavernous sinus fistula (CCF) caused by a ruptured aneurysm of the persistent primitive trigeminal artery (PPTA) is rarely reported. A 69-year-old woman presented with progressive ptosis and pulsating tinnitus. Vertebral angiography under flow control of the internal carotid artery revealed CCF associated with a ruptured PPTA-trunk aneurysm, and PPTA was divided into Saltzman type 2. Read More

BMC Ophthalmol 2022 Jan 24;22(1):37. Epub 2022 Jan 24.

Department of Ophthalmology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea.

Background: Carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system and exhibits typical symptoms of red eye, diplopia, blurred vision, headache, and murmur. However, the symptoms for CCF may vary and can lead to misdiagnosis. IOP pulsations provide a hint leading to suspicion of CCF. Read More

J Neurol Surg A Cent Eur Neurosurg 2022 Jan 24. Epub 2022 Jan 24.

Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia.

Background:  Indirect carotid-cavernous fistulas (iCCFs) are shunts between meningeal branches of the internal carotid and/or the external carotid arteries and the cavernous sinus. They account for 83% of all carotid-cavernous fistulas (CCFs). Symptomatic iCCFs and those with increased risk of hemorrhage should be treated. Read More

Acta Neurochir (Wien) 2022 05 24;164(5):1287-1292. Epub 2022 Jan 24.

Division of Neurosurgery, University of British Columbia, Vancouver, Canada.

Carotid-cavernous fistulas (CCFs) are abnormal vascular shunts between the carotid artery and the cavernous sinus. A 37-year-old male presented with a traumatic CCF and basal skull fracture extending through the medial wall of the cavernous sinus and sphenoid sinus. The CCF was treated with endovascular coiling. Read More

Cureus 2021 Nov 18;13(11):e19696. Epub 2021 Nov 18.

Ophthalmology, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS.

A carotid-cavernous fistula (CCF) is an arteriovenous fistula with an abnormal connection between the carotid artery and cavernous sinus that can be sight and life-threatening. The conjunctival injection is often the most prominent feature, and patients are commonly misdiagnosed for other ocular conditions leading to a delay in diagnosis and treatment. All three patients in this case series presented with persistent red eyes. Read More

Clin Neuroradiol 2022 Mar 21;32(1):117-122. Epub 2021 Dec 21.

Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.

Purpose: The aim of this study was to determine local diagnostic reference levels (DRLs) during endovascular diagnostics and therapy of carotid-cavernous fistulas (CCF).

Methods: In a retrospective study design, DRLs, achievable dose (AD) and mean values were assessed for all patients with CCF undergoing diagnostic angiography (I) or embolization (II). All procedures were performed with the flat-panel angiography system Allura Xper (Philips Healthcare). Read More

J Cerebrovasc Endovasc Neurosurg 2021 Dec 17;23(4):293-303. Epub 2021 Dec 17.

Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Cavernous sinus dural arteriovenous fistulas (CSDAVFs) are arteriovenous shunts between small dural branches arising from the external and/or internal carotid arteries and the cavernous sinus (CS). And now a days, endovascular treatment is the treatment of choice in CSDAVF. We review the anatomy and classifications of CSDAVFs, discussing and detailing these considerations in the treatment of CSDAVFs, theoretically and in the light of recent literatures. Read More

Clin Neuroradiol 2021 Dec 15. Epub 2021 Dec 15.

UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy.

Purpose: Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs.

Methods: PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. Read More

Arq Bras Oftalmol 2021 Nov 29. Epub 2021 Nov 29.

Department of Ophthalmology, University Hospital of Virgen de las Nieves de Granada, Granada, Spain.

Direct carotid-cavernous fistula is a high-flow communication between the internal carotid artery and the cavernous sinus that requires early transarterial embolization for its resolution. We report a case of a patient with a direct carotid-cavernous fistula who subsequently developed a central retinal vein thrombosis due to a delay in treatment related to the health collapse experienced in the first months of the Covid-19 pandemic in Spain. Read More

J Stroke Cerebrovasc Dis 2022 Jan 22;31(1):106180. Epub 2021 Nov 22.

Penn State Health Milton S. Hershey Medical Center, Department of Neurosurgery, 500 University Dr. Hershey, PA, 17033, USA. Electronic address:

Background: The use of flow diverters as a first-line treatment for direct carotid cavernous fistula (CCF) is a relatively new approach in the neurointerventional field which allows obliteration of the fistula with less mass effect from coils in the cavernous sinus. Safe and successful deployment of a flow diverter requires adequate imaging of the parent vessel, which may be challenging in the setting of high-flow CCF without antegrade flow.

Objective: To facilitate adequate parent vessel imaging in the setting of high-flow CCF to enable the safe development of a flow diverter device. Read More

BMJ Case Rep 2021 Nov 11;14(11). Epub 2021 Nov 11.

Neurology, Acibadem City Clinic cardiovascular Center, Sofia, Bulgaria.

Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Read More

Chin Neurosurg J 2021 Nov 4;7(1):46. Epub 2021 Nov 4.

Department of Neurosurgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, No. 182, Tongguan Road, Lianyungang, 222000, Jiangsu, China.

Background: Carotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures. The traumatic bilateral carotid cavernous fistula are significantly rarer.

Case Presentations: We report a case of a 61-year-old man presenting with unilateral exophthalmos, swollen eyelids, conjunctival congestion, and edema etiologically associated with severe trauma. Read More

R I Med J (2013) 2021 Nov 1;104(9):70-72. Epub 2021 Nov 1.

Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI.

Indirect carotid cavernous fistulas (CCFs) are most often spontaneous, but can rarely be caused by trauma. With traumatic etiology, the timeline for the development of symptoms varies significantly and can be difficult to predict. In this report, we discuss the case of a patient found to have an indirect CCF who presented for acutely worsening ocular symptoms and a history of pulsatile tinnitus that began two years prior after a suspected inciting head injury. Read More

Front Neurol 2021 6;12:739222. Epub 2021 Oct 6.

The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.

To investigate the safety and efficacy of Willis covered stents (WCS) in the treatment of traumatic pseudoaneurysm of the cranial internal carotid artery (CICA). Fifteen patients with traumatic pseudoaneurysm of the intracranial segment of the ICA treated with the WCS system at our institution from 2013 to 2019 were analyzed retrospectively. Follow-up observation and digital subtraction angiography (DSA) examination were conducted ~6 months after the treatment. Read More