• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.153-158
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• 2001

Traumatic carotid-cavernous fistula is a rare complication of moderate to severe head injury. For the treatment of carotid-cavernous fistula, detachable balloon occlusion is the best method of choice. A 26 year old male patient was hurt with a left periorbital penetrating injury 20 years ago, and then left side exophthalmos, bruit and right hemiparesis developed 10 years later. We experienced the very rare case of direct carotidcavernous fistula with cavernous dural arteriovenous fistula. Brain MRIs and cerebral angiograms revealed that direct carotid-cavernous fistula was accompanied by cavernous dural arteriovenous fistula due to longstanding venous hypertension and development of collateral circulation. Detachable balloon occlusion and surgical internal carotid artery ligation were not enough to occlude fistular flow, so cavernous dural arteriovenous fistula embolization was necessary. The authors present a case of long-standing traumatic carotid-cavernous fistula with cavernous dural arteriovenous fistula, with review of the literature.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.155-157
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• 2005

Spontaneous intracerebral hemorrhage associated with traumatic carotid-cavernous fistula is rare. The cardinal symptoms of traumatic carotid-cavernous fistula are confined to ocular manifestations. This article describes a case of traumatic carotid-cavernous fistula which was initially diagnosed as an intracerebral hemorrhage, after ocular symptoms were overlooked. Because some cases of carotid-cavernous fistula have an atypical drainage which can result in intracerebral hemorrhage, early diagnosis and intervention are vital to prevent this unwanted intracerebral hemorrhage.

• Archives of Craniofacial Surgery
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• v.11 no.2
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• pp.116-119
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• 2010

Purpose: Arteriovenous fistulas that involve the cavernous sinus often produce ophthalmologic symptoms and signs. Transvenous endovascular access is the method of choice for a carotid-cavernous sinus fistula. The superior ophthalmic vein is a safe and reasonable alternative route for the transvenous embolization of carotid-cavernous sinus fistula. We report a case of the embolization of a carotid-cavernous sinus fistula using the superior ophthalmic vein approach. Methods: A 58 year old female had conjunctival congestion, periocular pain and diplopia with a 2 month duration. Diagnostic orbital CT, brain MRI and cerebral angiography revealed a carotid-cavernous sinus fistula. The fistula occlusion was treated by coil embolization using the superior ophthalmic vein approach. Results: The initial presenting symptoms, conjunctival congestion, periocular pain and diplopia, decreased after surgery. Coil embolization via the superior ophthalmic vein approach was difficult because of the venous tortuosity and friability. During the follow up period, the patient was in a good condition without complications. Conclusion: Surgical exposure of the superior ophthalmic vein provides direct venous access to the cavernous sinus as well as an effective and safe treatment approach. The cooperation of the plastic surgeon and interventionist is a factor in successful treatment.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.44-47
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• 2019

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotid-cavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7-8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.243-248
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• 2000

Carotid cavernous sinus fistula(CCSF) is an abnormal communication at the base of the skull between the internal carotid artery and the cavernous sinus. Fistula is almost associated with extensive facial trauma as a result of direct or indirect forces. Most fistulas of traumatic origin develop as a result of fractures through the base of the skull, which cause the laceration of the internal carotid artery near the cavernous sinus. The signs and symptoms of CCSF are pulsating exophthalmosis, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia and ophthalmoplegia. Angiography reveals a definite CCSF and a detachable balloon embolization is known to be the treatment of choice. Even though carotid cavernous sinus fistula is an uncommon complication after orthognathic surgery, several cases of CCSF due to congenital anomalies, pre-existing aneurysms and abnormally thickened maxillary posterior wall have been reported in the literature. We have experienced a case of CCSF after Le Fort I osteotomy for maxillary advancement in skeletal class III patient and the cause, pathogenesis, diagnosis and treatment of this case.

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.323-326
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• 2007

Direct carotid-cavernous fistula [CCF] is a common post-traumatic disease. However, pseudoaneurysm formation after balloon occlusion is a rare complication. The author present such a case with review of the literature. A 26-year-old man involved in a motor vehicle accident as a driver. Only mild conjunctival injection and minimal exophthalmos on the right eye were noted after trauma. However, angiography revealed a direct CCF and dissection of the proximal intracranial internal carotid artery [ICA]. After first balloon occlusion of the CCF, the patient redeveloped fistula due to early deflation of the balloon. After the second balloon occlusion, pseudoaneurysm and diplopia were developed with the change of balloon position and shape. However, visual symptom spontaneously resolved and pseudoaneurysm was also decreased within 6 months after balloon occlusion.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.226-228
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• 2011

We report a case of spontaneous right carotid-cavernous fistula (CCF) in a proximal segment of persistent primitive trigeminal artery (PPTA) and combined vascular anomalies such as left duplicated hypoplastic proximal posterior cerebral arteries and a variation of anterior choroidal artery supplying temporal and occipital lobe. A 45-year-old male presented with progressive right exophthalmos, diplopia, and ocular pain. With manual compression of the internal carotid artery, a cerebral angiography revealed a right CCF from a PPTA. Treatment involved the placement of detachable non-fibered and fibered coils, and use of a hyperglide balloon to protect against coil herniation into the internal carotid artery. A final angiograph revealed complete occlusion of PPTA resulted in no contrast filling of CCF.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.229-230
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• 2011

Visual loss is one of the ocular symptoms resulting from a carotid cavernous fistula (CCF), but has rarely been reported as the sole manifestation in CCF. Visual impairment is known to be associated with a poor outcome unless timely intervention is employed. Herein, the authors report a patient with bilateral rapid progressing visual loss as a sole manifestation in CCF. Vision was successfully restored by transarterial embolization. The authors discuss the necessity of urgent fistula obliteration in patients with visual loss.

• Journal of Korean Neurosurgical Society
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• v.55 no.2
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• pp.92-95
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• 2014

Ehlers-Danlos syndrome (EDS) is a rare inherited connective disease. Among several subgroups, type IV EDS is frequently associated with spontaneous catastrophic bleeding from a vascular fragility. We report on a case of carotid-cavernous fistula (CCF) in a patient with type IV EDS. A 46-year-old female presented with an ophthalmoplegia and chemosis in the right eye. Subsequently, seizure and cerebral infarction with micro-bleeds occurred. CCF was completely occluded with transvenous coil embolization without complications. Thereafter, the patient was completely recovered. Transvenous coil embolization can be a good treatment of choice for spontaneous CCF with type IV EDS. However, every caution should be kept during invasive procedure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.2
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• pp.100-104
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• 1993

Carotid-cavernous sinus fistula(CCSF) is an abnormal arterio-venous communication between the cavernous sinus and the internal carotid artery. It is usually caused by craniofacial trauma and a very rarely encountered complication, but it may also occur spontaneously. The most common cause of traumatic CCSF is blunt trauma, which usually associated with a skull base, frontal or midfacial fracture. The common clinical feature of CCSF are orbital bruit, headache, exophthalmos, chemosis, diplopia, visual disturbance and others. This dramatic ocular-orbital symptoms are principally due to orbital venous hypertension. The symptoms occured within a few hours to a maximum of a year after injury, usually within several weeks. The patient, 33-year-old female, developed a carotid-cavernous sinus fistula after only minimal closed trauma We present a rare case of CCSF associated facial bone fracture that was successfully treated by detachable balloon embolization with a review of the literature.