Direct Carotid-Cavernous sinus Fistula Following Closed Head Injury
International Clinical Neuroscience Journal,
Vol. 2 No. 3 (2015),
30 December 2015
A case of direct carotid-cavernous sinus fistula (CCF) after closed head injury is presented. A
22-year-old male presented to the emergency department of Shohada Tajrish Hospital with the
chief complaint of blurred vision and pulsatile retro-orbital headache. The patient had closed head
injury due to car accident 2 month ago with lower limb fracture. After a 2-week symptom-free
period, he developed scalp and right facial tingling, along with pulsatile retro-orbital headache
and vision problems. His vital signs were within normal limits, but on primary evaluation
the patient orbital and carotid bruits could be recognized. Computed tomography (CT) scan
and magnetic resonance imaging (MRI) suggested the carotid-cavernous sinus fistula, which
was confirmed by brain angiographic imaging findings. Carotid-cavernous sinus fistula is an
uncommon condition that is usually caused by head trauma but can advance spontaneously in
about one fourth of patients with CCF. The connection between the carotid artery and cavernous
sinus leads to increased pressure in the cavernous sinus and compression of its contents, and
finally advances the clinical symptoms and signs seen. Diagnosis is based on clinical evaluation
and neuroimaging techniques. The target of management is to decrease the pressure within the
cavernous sinus, which results in gradual recovery of symptoms.
How to Cite
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 May;163(2):437-42.
Viñuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG.
Spontaneous carotid-cavernous fistulas: clinical, radiological,
and therapeutic considerations. Experience with 20 cases.
J Neurosurg. 1984 May;60(5):976-84.
Halbach VV, Hieshima GB, Higashida RT, Reicher M.
Carotid cavernous fistulae: indications for urgent treatment.
AJR Am J Roentgenol. 1987 Sep;149(3):587-93.
Lewis AI, Tomsick TA, Tew JM Jr. Management of 100
consecutive direct carotid-cavernous fistulas: results
of treatment with detachable balloons. Neurosurgery.
Lewis AI, Tomsick TA, Tew JM Jr, Lawless MA. Long-term
results in direct carotid-cavernous fistulas after treatment
with detachable balloons. J Neurosurgery. 1996;84(3):400–
Debrun G, Lacour P, Vinuela F, Fox A, Drake CG, Caron
JP. Treatment of 54 traumatic carotid-cavernous fistulas.
J Neurosurg. 1981 Nov;55(5):678-92.
Chaudry AI. Carotid cavernous fistula: ophthalmological
implications. Middle East Afr J Ophthalmology.
Aquini MG, Marrone AC, Schneider FL. Intercavernous
venous communications in the human skull base. Skull
Base Surg. 1994;4(3):145-50.
Abrahamson IA Jr, Bell LB Jr. Carotid-cavernous fistula
syndrome. Am J Ophthalmol. 1955;39:521–526.
Keltner JL, Satterfield D, Dublin AB, Lee BC. Dural and
carotid cavernous sinus fistulas. Diagnosis, management, and
complications. Ophthalmology. 1987 Dec;94(12):1585-600.
Barrow DL, Spector RH, Braun IF. Classification and
treatment of spontaneous carotid cavernous sinus fistulas.
J Neurosurg. 1985;62:248–256.
Locke CE. Intracranial arteriovenous aneurism or pulsating
exophthalmos. Ann Surg. 1924;80:1–24.
Gemmete JJ, Chaudhary N, Pandey A, Ansari S. Treatment
of carotid cavernous fistulas. Curr Treat Options Neurol.
Corradino G, Gellad FE, Salcman M. Traumatic carotid
cavernous fistula. South Med J. 1988;81(5):660–663.
- Abstract Viewed: 257 times
- PDF Downloaded: 265 times