Carotid-cavernous fistula from the perspective of an ophthalmologist A Review

Česká verzia

Authors: J. Čmelo
Authors place of work: Centrum neurooftalmológie, Bratislava
Published in the journal: Čes. a slov. Oftal., 76, 2020, No. 5, p. 203-210
Category:
doi: https://doi.org/10.31348/2020/8

Summary

Carotid-cavernous fistula (CCF) is an abnormal communication - vascular connection between arteries and veins in the cavernous sinus. Classification according to etiology is traumatic vs spontaneous. According to blood flow rate per high flow vs low flow fistula. According to anatomy of direct vs indirect: Direct (direct) CCF arises through direct communication between the internal carotid artery (ICA) and the cavernous sinus. Indirect CCF originates through indirect communication through the meningeal branches of ICA, external carotid artery and cavernous sinus (not directly with ICA) and Barrow type A, B, C, D division. Patient‘s subjective complaints depend on the type of CCF. Most often it is pulsating tinnitus, synchronous with blood pulse. Typical findings include protrusion and pulsation of the eyeball, corkscrew vessels - arterialization of conjunctival and episleral vessels, increased intraocular pressure, not responding to local antiglaucomatous therapy, keratopathy a lagophthalmo, corneal ulcers. In the later untreated stages of CCF, secondary, venous stasis or central retinal vein occlusion can occur. Diagnostic procedures include B-scan and color Doppler ultrasonography, digital ophthamodynamometry, computer tomography, nuclear magnetic resonance and digital subtraction angiography. CCF can simulate orbitopathy, conjunctivitis symptoms, carotid occlusion, scleritis or cavernous sinus thrombosis. The ophthalmologist should recognize and indicate the necessary examinations in a timely manner. The therapy is ophthalmological, neuroradiological, sterotactic, surgical and conservative.

Keywords:

carotid-cavernous fistula – cavernous sinus – caput medusae – corkscrew vessels – proptosis – venous stasis – exophthalmos – ocular pathology – ultrasonography

Zdroje

1. Ellis JA, Goldstein H, Connolly ES Jr, Meyers PM. Carotid-cavernous fistulas. Neurosurg Focus. 2012;32(5):1–11.

2. Liang W, Xiaofeng Y, Weiguo L et al. Traumatic carotid cavernous fistula accompanying basilar skull fracture: A study on the incidence of traumatic carotid cavernous fistula in the patients with basilar skull fracture and the prognostic analysis about traumatic carotid cavernous fistula. J Trauma. 2007;63(5):1014–1020.

3. Biousse V, Mendicino ME, Simon DJ, Newman NJ. The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol. 1998;125:527–544.

4. Chynoranský M, Pener V, Čmelo J. Obojstranná spontánna karotido-kavernózna fistula so spontánnym obojstranným uzáverom [Bilateral spontaneous carotical-cavernousus fistula with spontaneous bilateral closure]. Choroby hlavy a krku [Head and Neck Diseases]. 1994;3-4:35–37. Slovak.

5. Abu SHM et al. Bilateral indirect carotid cavernous fistula post trivial injury- A case report. Journal of Acute Disease. 2013;66–69. Available from: journal homepage: www.jadweb.org.

6. Zhu L, Liu, B. & Zhong, J. Post-traumatic right carotid-cavernous fistula resulting in symptoms in the contralateral eye: a case report and literature review. BMC Ophthalmol. 2018 18(183); Available from: https://doi.org/10.1186/s12886-018-0863-6.

7. Rwiza HT, Vliet AV, Keyser A et al. Bilateral spontaneous carotid-cavernous fistulas, inatic hypertension and generalised arteriosclerosis: a case report. J.Neurol. Neurosurgery and Psychiatry. 1998 51;7:1008-1005.

8. Naesens R, Mestdagh C, Breemersch M, Defreyne L. Direct carotid-cavernous fistula: A case report and review of the litarature. Bull. Soc. Belge Ophtalmol. 2006;299:43–54.

9. Debrun GM, Vinuela F, Fox AJ et al. Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery. 1988;22(2):285–289.

10. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985;62(2):248–256.

11. Fattahi TT, Brandt MT, Jenkins WS, Steinberg B. Traumatic carotid-cavernous fistula: pathophysiology and treatment. J craniofacial surgery. 2003;14(2):240–246.

12. Jirásková J, Kadlecová J, Rencová E, Studnička J, Rozsíval P. Hodnocení edému terče zrakového nervu. Cesk Slov Neurol, 2007; 70/103:547–551.

13. Barke RM, Yoshizumi MO, Hepler RS, Krauss HR, Jabour BA. Spontaneous dural carotid-cavernous fistula with central retinal vein occlusion and iris neovascularization. Ann Ophthalmol. 1991;23:11–17.

14. Ishijima K, Kashiwagi K, Nakano K. et al. Ocular manifestations and prognosis of secondary glaucoma in patients with carotid-cavernous fistula. Jpn J Ophthalmol. 2003; 47:603–8.

15. Rehák M, Řehák J, Jurečka T: Venózní okluze sítnice, I. vyd. Praha (Česká republika): Grada Publishing as; 2011. Kapitola 6, Patofyziologie venózního uzávěru v sítnici; p.57–62.

16. Alam MS, Jain M, Mukherjee B et al. Visual impairment in high flow and low flow carotid cavernous fistula. Sci Rep. 2019;9(12872). Available from: https://doi.org/10.1038/s41598-019-49342-3.

17. Jonas JB, Groden C. Spontaneous carotid-cavernous sinus fistula diagnosed by ophthalmodynamometry. Acta Ophthalmol Scand. 2003 Aug;81(4):419–420.

18. Adam CR, Shields CL, Gutman J. et al. Dilated superior ophthalmic vein: clinical and radiographic features of 113 cases. Ophthalmic Plast Reconstr Surg. 2018;34(1):68–73.

19. Henderson AD, Miller NR. Carotid-cavernous fistula: current concepts in aetiology, investigation, and management. Eye (Lond) 2018;32(2):164–172

20. Latt H, Kyaw K, Yin HH, Kapoor D, Aung SSM, Islam R. A Case of Right-Sided Direct Carotid Cavernous Fistula: A Diagnostic Challenge. Am J Case Rep. 2018 Jan;12:47–51.

21. Kasl Z, Rusňák Š, Matušková V, Peterka M, Sobotka P, Jirásková N. Současné možnosti oftalmologické diagnostiky a spolupráce oftalmologa s neurologem u pacientů s idiopatickou intrakraniální hypertenzí [The Current Diagnostic Possibilities and Cooperation of Oftalmologist and Neurologist Concerning in Patients with Idiopatic Intracranial Hypertension]. Ces Slov Oftal. 2016;72(2): 32–38. Slovak.

22. Cohen AW, Allen R, Choi D. et al. Acute Post-traumatic Direct Carotid Cavernous Fistula. EyeRounds.org. 2019 December 18; [last updated: 1-13-2020]. Available from: https://webeye.ophth.uiowa.edu/eyeforum/cases/111-Carotid-Cavernous-Fistula.htm.

23. Karhanová M, Kovář R, Fryšák Z. et al. Postižení okohybných svalů u pacientů s endokrinní orbitopatií [Extraocular Muscle Involvement in Patients with Thyroid-associated Orbitopathy]. Ces Slov Oftal. 2014;2:66–71. Slovak.

24. Karhanová M, Fryšák Z, Šín M, Zapletalová J, Řehák J, Herman M. Correlation between magnetic resonance imaging and ultrasound measurements of eye muscle thickness in thyroid-associated. Biomedical papers of the Medical Faculty of the University Palacký, Olomouc Czech Republic. 2015;159(2):307–312.

25. Celik O, Buyuktas D, Islak C, Sarici AM, Gundogdu AS. The association of carotid cavernous fistula with Graves' ophthalmopathy. Indian J Ophthalmol. 2013;61(7):349–351.

26. Furdová A, Babál P, Kobzová S. Meningeómy zrakového nervu očnice [Optic nerve orbital meningioma]. Ces Slov Oftal. 2018;74(1):23–30. Slovak.

27. Polster SP, Zeineddine HA, Baron J, Lee S-K, Awad IA. Patients with cranial dural arteriovenous fistulas may benefit from expanded hypercoagulability and cancer screening. J Neurosurg. 2018 Oct;129(4):1–7.

28. Thinda S, Melson MR, Kuchtey RW. Worsening angle closure glaucoma and choroidal detachments subsequent to closure of a carotid cavernous fistula. BMC Ophthalmol. 2012 12(28); Available from: https://doi.org/10.1186/1471-2415-12-28.

29. Yeung, S. W. et al. Spontaneous carotid cavernous fistula complicating pregnancy. Hong Kong Med. J. 2013;19(3):258–261.

30. Debrun GM, Aletich VA, Miller NR. Et al. Carotid-cavernous fistulas. Neurosurg Focus. 2012;32(5):E9. Available from: https://PubMed.gov/22537135. DOI: 10.3171/2012.2.Focus1223].

31. Higashida RT, Hieshima GB, Halbach VV, Bentson JR, Goto K. Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein. Acta Radiol Suppl. 1986;369:580–583.

32. Chuman H, Trobe JD, Petty EM et al. Spontaneous direct carotid-cavernous fistula in Ehlers-Danlos syndrome type IV: two case reports and a review of the literature. J Neuro-ophthalmol. 2002;22(2):75–81.

33. Furdová A, Juhás J, Šramka M, Králik G. Liečba melanómu corpus ciliare stereotaktickou rádiochirurgiou [Ciliary body melanoma treatment by stereotactic radiosurgery]. Ces Slov Oftal. 2017;73(5–6):204–210. Slovak.

34. Friedman JA, Pollock BE, Nichols DA, Gorman DA, Foote RL, Stafford SL. Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. J Neurosurg. 2001;94:886–891.