Carotid-cavernous fistula and its surgical management

Summary The results of surgical treatment in 24 cases of c.c.f. are reported. 21 patients were subjected to ligation of the carotid vessels in the neck and 9 of them to progressive ligation of the feeding arteries. Another 3 cases were subjected to the one-stage operation ofHamby, i.e. clipping of the intracranial carotid artery followed by embolisation of the fistulous segment of the carotid and occlusion of the common, external and internal carotid arteries at the neck. On the strength of these personal results and of the data in the literature, it is concluded that the one-stage operation proposed byHamby in 1964 is the soundest method of treating c.c.f.

---

Zusammenfassung Es wird über die Ergebnisse der chirurgischen Behandlung von 24 Fällen mit Karotis-Kavernosus-Aneurysma berichtet. Bei 21 Patienten wurden die Karotisgefäße am Hals unterbunden. Bei 9 dieser Fälle waren weitere Unterbindungen von zuführenden Arterien erforderlich. 3 weitere Fälle wurden nach dem vonHamby angegebenen einzeitigen Verfahren operiert (Klippen der intrakraniellen Karotis mit anschließender Embolisierung des Fistelabschnittes der Karotis und Verschluß der Arteria carotis communis, externa und interna am Hals). Auf Grund der persönlichen Erfahrungen und der Berichte des Schrifttums kommen die Autoren zu dem Schluß, daß die 1964 vonHamby angegebene einzeitige Operationsmethode allen anderen Verfahren überlegen ist.

---

Resumen Se refieren los resultados del tratamiento quirúrgico de 24 casos de fístulas carótido-cavernosas. 21 enfermos fueron sometidos a la ligadura de la carótida en el cuello y 9 de ellos a la ligadura progresiva de las mismas. Otros tres casos se trataron mediante intervención en un tiempo deHamby, es decir al clipaje de la arteria carótida interna intracraneal, seguido de embolización del segmento fistuloso de la carótida y oclusión de las arterias carótidas primitivas, interna y externa en el cuello. Basandose en estos casos personales y en los hallazgos de la literatura los autores concluyen que la operación en un solo tiempo propuesta porHamby en 1964 es el método mag seguro para el tratamiento de las fístulas carótido-cavernosas.

---

Résumé Les résultats du traitement chirurgical de 24 cas de fistules caroticocaverneuses sont rapportés. 21 patients furent soumis à la ligature des vaisseaux carotidiens au cou et 9 d'entre eux à la ligature progressive des artères afferentes. Trois autres cas furent traités par l'intervention en un temps deHamby, c'est-à-dire clipage de l'artère carotide interne intracrânienne suivi par l'embolisation du segment fistule de la carotide et occlusion des artères carotides primitives, interne et externe au cou. En s'appuyant sur ces cas personnels et sur les données de la littérature, les auteurs concluent que l'opération en un temps proposée en 1964 parHamby est la méthode la plus sure du traitement des fistules carotico-caverneuses.

---

Riassunto Vengono riportati i risultati del trattamento chirurgico di 24 casi di fistola carotido-cavernosa. 21 pazienti furono sottoposti alla legatura dei vasi carotidei al collo e 9 di essi alla legatura progressiva delle arterie afferenti. Altri 3 casi furono sottoposti all'intervento in un solo tempo diHamby, con chiusura della carotide intracranica seguita da embolizzazione del segmento fistoloso e legatura al collo della carotide comune, dell'interna e dell'esterna. Sulla base di questi risultati personali e dei dati della letteratura, si conclude che l'intervento in un tempo proposto daHamby nel 1964 è il miglior metodo per il trattamento della fistola carotido-cavernosa.

     

Carotid-cavernous fistula following percutaneous retrogasserian procedures. Report of two cases.

Carotid arterial puncture during percutaneous retrogasserian procedures is a common but usually harmless complication. Strokes, resulting presumably from carotid artery thrombosis, have been reported previously following percutaneous retrogasserian coagulation. The authors report two cases of carotid-cavernous fistula, one following percutaneous radiofrequency rhizotomy and the other after percutaneous retrogasserian block. The latter patient had an anomaully by intracavernous injection of isobutyl-2 cyanoacrylate, using intra-arterial balloon flotation catheters. Carotid-cavernous fistula is a potentially serious complication of such procedures, and may be more common than realized since small fistulas may close spontaneously.     

Carotid-cavernous fistula after blunt trauma to the neck

Carotid-cavernous fistulas (CCF) are uncommon conditions, but cause significant morbidity if untreated. The majority of CCFs in young men are attributed to direct skull trauma. We present a case of CCF following a blunt injury to the neck.     

Carotid-cavernous sinus fistula presenting as a posterior fossa mass. Case report.

The authors report a case in which trigeminal neuralgia and hearing loss developed 14 years after a severe head injury. Arteriography demonstrated a carotid-cavernous sinus fistula producing a large venous mass in the posterior fossa.     

Carotid-cavernous sinus fistula complicating a complex shotgun facial injury

Carotid-cavernous sinus fistula is a rare but major complication of severe head injuries. This pathological communication between the internal carotid artery and the surrounding cavernous sinus at the base of the skull may result in marked retinopathy, optic atrophy with permanent loss of vision, and, rarely, fatal epistaxis. Physical signs of this entity are pathognomonic and include marked chemosis, pulsating exophthalmos, and a pulse-synchronous supraorbital bruit. Diagnosis is confirmed by carotid angiography or computed tomography scan. Treatment modalities range from internal carotid ligation to catheter embolectomy and, at times, observation. A patient with carotid-cavernous sinus fistula following complex facial trauma is described. The differential diagnosis and management of this rare pathological entity is discussed. In their position as primary consultants of head and neck trauma, plastic and reconstructive surgeons should be aware of both the diagnosis and management of this unusual condition.     

Carotid-cavernous sinus fistula associated with a primitive trigeminal artery

Carotid-cavernous sinus fistulas are not rare, but they have never been reported in association with persistent primitive trigeminal artery. We recently encountered such a case. The Jaeger-Hamby procedure was employed, with mandatory occlusion of the primitive trigeminal artery.     

多层螺旋CT血管成像诊断颈动脉海绵窦瘘

目的探讨颈动脉海绵窦瘘(CCF)的解剖病理基础及螺旋CT血管成像(MSCTA)表现,提高MSCTA对CCF的诊断能力。方法12例经DSA证实的CCF均进行了螺旋CT平扫、增强扫描及血管成像重建。结果CCF的MSCT及CTA表现为:海绵窦扩大及眼上静脉扩张12例,并与颈内动脉同时显影;其他属支静脉扩张6例;对侧海绵窦扩大4例,与DSA检查结果一致。患侧眼球突出12例。颅底、眶壁骨折5例。眼球壁模糊、增厚5例。脑挫伤、出血4例。眼外肌增粗1例。结论螺旋CT及其血管成像诊断CCF简单、快捷、准确、可靠,特别是在外伤性CCF中,是首选的检查及诊断方法。     

Carotid-cavernous sinus fistula: delayed diagnosis following road traffic accident

We present the case of a patient who sustained a blunt head injury resulting in a delayed diagnosis of a carotid-cavernous sinus fistula. Although rare in occurrence, a high index of suspicion is paramount with a history of head injury and developing signs in the eyes and face. Prompt referral to senior ophthalmic and neurosurgical teams is indicated to prevent the possibility of permanent visual loss with this condition.     

Carotid-cavernous fistula associated with traumatic aneurysm of the internal carotid artery

We report a patient who suffered two traumatic lesions in the same internal carotid artery-a carotid-cavernous fistula and a traumatic aneurysm of the cavernous portion of the internal carotid artery. Both lesions were treated by trapping procedure combined with controlled muscle embolization. The value of intraoperative angiography is emphasized.     

Treatment of ischemia due to "steal" by arteriovenous fistula with distal artery ligation and revascularization

Three cases are described of upper extremity ischemia occurring after the creation of fistulas (AVFs) (one case) and bridge AVFs (two cases) for hemodialysis access. All three cases were successfully treated with ligation of the artery immediately distal to the origin of the AVF in conjunction with a reversed saphenous vein bypass. The latter was constructed from the artery proximal to the origin of the fistula to the artery distal to the site of ligation. Preoperative and postoperative hemodynamic measurements and complete disappearance of symptoms indicated that this procedure corrected the ischemic steal phenomenon. Angioaccess function was not affected in these three cases, thereby allowing continuation of its use immediately after corrective surgery and for follow-up periods of 1 month, 6 months, and 8 years.