Carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. Highflow direct ccfs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. A cerebral angiogram revealed an early venous blush in the region of the left cavernous sinus figure 2. Carotid cavernous fistulas ccfs are an abnormal shunt from the carotid artery to the cavernous sinus. There are many available sequences, although the values of these sequences have not been tested against each other or for different properties of fistula inano. Magnetic resonance angiography source images in carotid. The magnetic resonance mr images of 12 patients with angiographically proved davf were evaluated to.
It spans from the apex of the orbit to the apex of the petrous temporal bone. Data will be collected before, during and after the arteriovenous fistula avfplacement, and during followup at predefined time intervals. Background perianal fistula is an abnormal communication between the anal canal and the perianal skin. In case of positive ddimer testing or in patients with a high probability of pe, mri and a venous ultrasonography of the legs are done. Patients with carotico cavernous fistula ccf present with a pulsatile swelling in the eye. Examination of magnetic resonance angiography mra source images, in addition to the conventional mra reconstructions, is now also recognised as a useful method of detecting ccf. Caroticocavernous fistula radiology reference article. Magnetic resonance imaging depicts infectious foci in the perianal region better than any. The use of magnetic resonance imaging in predicting the. An aortocaval fistula may be the consequence of penetrating injuries, such as stab or gunshot wounds, or even, exceptionally, of blunt trauma. Mri for assessment of anal fistula pubmed central pmc. Background intraoperative imaging during surgical ligation of a spinal dural arteriovenous fistula sdavf is usually based on fluorescence angiography, intraoperative doppler ultrasound, and intraoperative digital subtraction angiography. Imaging diagnosis of dural and direct cavernous carotid fistulae.
A three plane localiser must be taken in the beginning to localise and plan the sequences. The use of magnetic resonance imaging in predicting. Carotid cavernous fistulas ccfs are an abnormal shunt from the carotid. Abstract a carotid cavernous fistula ccf is an abnormal communication between the venous cavernous sinus and the carotid artery. Anal canal, levator ani complex are normal in appearance. In most instances, endovascular treatment is preferred. Oct 28, 2015 carotid cavernous fistulas ccfs are abnormal communications between the carotid arterial system and the venous cavernous sinus. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. May 24, 2019 carotid cavernous sinus fistula is an abnormal communication between the internal or external carotid arteries and the cavernous sinus. We describe a case example with bilateral barrow type b.
Several investigations, including magnetic resonance imaging mri, computed tomography ct, and orbital ultrasound are used to noninvasively screen for carotid cavernous fistula ccf, with variable results. Computed tomography suggested a carotid cavernous fistula ccf, which was confirmed by digital subtraction angiography and further classified as an indirect, barrow type d ccf. The preangiographic diagnosis of cerebral dural arteriovenous fistula davf can be difficult. Threedimensional fisp imaging in the evaluation of carotid cavernous fistula. Magnetic resonance imaging mri has emerged as the dominant method for such assessment, especially for the more complicated fistulae. At times a ccf can be secondary to a spontaneous rupture of an abnormal artery into the vein. The usefulness of the source images of magnetic resonance.
The source images of magnetic resonance angiogram mra may useful to detect the direction and magnitude of the collateral circulations in the patient with carotid cavernous fistula ccf. A 3yearold girl with trisomy 21 presented with progressive proptosis, scleral injection, and pulsatility of her right eye 1 month following minimal blunt head trauma. Sequences the most common sequences are t2weighted images with or without different forms of fat saturation, and t1weighted images before and after gadolinium enhancement and with fat saturation. Spine and spinal cord research institute, yonsei university. Axillary nerve block for upper extremity arteriovenous. The carotid cavernous fistula is a wellknown clinical entity in which the internal carotid artery ruptures within the cavernous sinus. Exophthalmos secondary to a carotid cavernous fistula. Diagnostic tests and imaging for a ccf depend on the acuity of the. The fistula tract between the ica and the cavernous sinus at segment 3 could be visualized by using cta panels ac and mra panels df. To describe the magnetic resonance imaging mri features and classification of perianal fistulas.
Transvenous coil embolization of an indirect, barrow type d. Caroticocavernous fistulas ccf represent abnormal communication between the carotid circulation and the cavernous sinus. Mr imaging was carried out using mri scanner optima mr 450 w 1. They are classified into dural cavernous sinus fistulae or direct carotid cavernous fistulae. Magnetic resonance imaging evaluation of perianal fistulas. To discuss the role of mri in the evaluation and management of perianal fistulas. Aortocaval fistula is a severe complication of abdominal aortic aneurysms that may be fatal and requires early diagnosis and prompt treatment. It most commonly results from contiguous spread of infection from a nasal furuncle 50%, sphenoidal or ethmoidal sinus infections 30% and dental infections 10%. Dural arteriovenous fistula radiology reference article.
Cavernous sinus thrombosis cst is a rare condition, most commonly infectious in nature, and the diagnosis on imaging is not always straightforward. Ultrasound to predict stealsyndrome after arteriovenous. The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. A retrospective analysis was made of 58 patients with carotid cavernous fistula who had complete clinical. Magnetic resonance imaging evaluation of perianal fistula. T1weighted brain mri showed left superior ophthalmic vein sov enlargement fig 1 1.
It is the least common dural venous sinus thrombosis, accounting for cavernous sinuses are paired dural venous sinuses gross anatomy. The cavernous sinus is located on either side of the pituitary fossa and body of the sphenoid bone between the endosteal and meningeal layers of the dura. This patient had a complete brain mri a month ago when headaches started, with findings only of old lacunar infarcts. A 68yearold woman presented with progressive bilateral pulsatile tinnitus, headache and diplopia accompanied by swelling of both eyes, the right eye being. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. The treatment of a carotid cavernous fistula ccf depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. The results from both cta and mra correlated well with the flow of contrast material observed in a va lateral views in panels h and i. Transcortical venous approach for direct embolization of a. No inflammation or fluid collection in the usual renal fossa or neither rectum.
Carotid cavernous fistula statpearls ncbi bookshelf. Treatment of carotid cavernous fistulas northwestern scholars. They present variably with hemorrhage or venous hypertension and can be challenging to treat. Imaging diagnosis of carotidcavernous fistula request pdf. The goal of this study was to analyze the value of different mr images including 3d contrastenhanced mr angiography mra with a high temporal resolution in diagnostic and followup imaging of davfs. Computed tomography and magnetic resonance imaging of the head demonstrated subtle enhancement in the left cavernous parasellar region, extending inferiorly to the gasserian ganglion. Preoperative ct imaging left images and postoperative mr. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotidcavernous fistulae, but it is possible to differentiate one type from the. Now we see typical findings of cavernous sinus trombosis cst. Type c ccfs are dural shunts between external carotid meningeal branches and the cavernous sinus fig. A combination of sequences was used as a protocol of mri pelvis in diagnosing perianal fistula. Type a ccfs are highflow direct shunts between the ica and the cavernous sinus fig. T2 weighted mr imaging showing swelling of the orbit and proptosis of the left. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein.
Cureus transorbital approach for endovascular occlusion of. Mri rectoveginal fistula planning mri rv fistula protocols. Ccf represents an abnormal communication from the carotid artery to the cavernous sinus. When transvenous access is not possible, an alternate approach must be devised. Unlike other dural venous sinuses, it is divided by numerous fibrous septa into a series of. Nov 09, 2011 this is a prospective study where the research team will acquire data from the patients after they have signed the informed consent form. Dural arteriovenous fistulas davf are a heterogeneous collection of conditions that share arteriovenous shunts from dural vessels. A 61yearold woman presented with a symptomatic ccf with all but one of the venous access routes to the ccf thrombosed, leaving an engorged superficial middle cerebral vein smcv as. The fistula may occur spontaneously but usually occurs following. Most dural arteriovenous fistulas present in adulthood and account for 1015% of all cerebral vascular malformations 6.
Right axial cect in a 70yearold man presenting with fever and hematemesis months after abdominal aortic aneurysm aaa repair shows the native, calcified aortic wall wrapped around a synthetic graft. Multiplanar and multisequental imaging helped us in interpretation of perianal fistula and associated complications especially obscured abscess formation. Ccfs can be classified based on the hemodynamic properties, the etiology or the anatomy of the shunt. Most often, ccfs are broadly classified as either direct or indirect, on the basis of anatomic features depicted on angiograms. Nov 16, 2016 aortoenteric fistula left graphic shows a fistula between the transverse duodenum and aorta at the site of the graftaortic suture line. Ccf can be traumatic or spontaneous, with the traumatic type being more common, representing 75% of all ccfs. Type b ccfs are dural shunts between meningeal branches of the cavernous ica arising from the meningohypophyseal or ilt trunks and the cavernous sinus fig. University of michigan offers latest therapies for carotidcavernous fistula ccf, an abnormal connection between carotid artery andor cavernous sinus. Comparison of different magnetic resonance imaging sequences. Digital subtraction angiography dsa is the method of reference for imaging of dural arteriovenous fistula davf. Cavernous sinus thrombosis radiology reference article. Diagnosis is established based on typical findings on ctmri or angiography e. Carotidcavernous fistula knowledge for medical students and.
Imaging diagnosis of dural and direct cavernous carotid fistulae ncbi. Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. Full size image demonstrated is the patients right abducens nerve palsy. Spinal arteriovenous fistulas and arteriovenous malformations.
Carotid cavernous fistulas ccfs pose an anatomically and physiologically challenging problem for clinicians. Magnetic resonance imaging mri and digital subtraction. The cavernous sinuses were symmetric and normal in size, with slightly increased flow voids in the left cavernous sinus. These lesions may be classified based on the following. Magnetic resonance angiography source images in carotid cavernous fistulas. A carotidcavernous fistula ccf is a pathologic shunt between the. Endovascular treatment of carotid cavernous fistulas ccfs via a transvenous approach is standard, but in rare cases this approach is challenging due to absence or thrombosis of the commonly used venous routes. In the setting of this clinical vignette, the axillary block with propofol sedation was an optimal anesthetic plan for an anxious patient with multiple medical comorbidities undergoing a repeat av fistula creation. Treatment of carotid cavernous fistulas springerlink. Preoperative, intraoperative, postoperative, 510 days, 46 weeks, 6 months, and 1 year. Magnetic resonance imaging has been shown to accurately demonstrate the anatomy of the perianal region as well as the fistulas relationship with the pelvic diaphragm and ischiorectal fossa, allowing the classification of fistulas into five types.