Clinical improvement in indirect carotid cavernous fistulas treated endovascularly: A patient based review
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Date
2021
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Abstract
Patients with indirect carotid cavernous fistulas (CCF) were reviewed to emphasize the importance of diagnosing patients even with trivial findings and to raise awareness. Eighteen patients diagnosed as CCF were included. Neuro-ophthalmological findings before and after treatment, diagnostic investigations, treatment, clinical course was noted. Twelve patients were female (67%), 6 were males (33%) and the mean age at presentation was 54 years (range: 29–70 years). Conjunctival hyperemia was present in all patients. Seventeen (94%) patients had proptosis and diplopia, nine (50%) had orbital pain and/or headache, four (22%) had blurred vision, one (5.5%) had ptosis. On examination, 17 patients (94%) had restricted eye movements, four (22%) had low visual acuity and five patients had (28%) increased intraocular pressure (IOP). One patient had been diagnosed as myasthenia gravis and two as thyroid orbitopathy and had been on treatment accordingly before CCF was diagnosed. In two patients, bilateral findings were present despite unilateral CCF on angiography. Barrow Type B fistula was found in 7 (38%), Barrow Type D in 11 (62%) patients. In three bilateral CCF was detected. All were treated by endovascular intervention. Residual deficits at the sixth month control were, eye movement deficits in seven (39%), decrease in visual acuity in one (5.5%) and elevated IOP in one (5.5%) patient. Indirect CCF patients generally present with mild symptoms and the diagnosis may be overlooked. Mild progressive ophthalmoparesis with conjunctival hyperemia must be warning. Though rare bilateral CCF can be detected as well as unilateral CCF with bilateral findings. © 2021
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Adult , Aged , Carotid-Cavernous Sinus Fistula , Endovascular Procedures , Exophthalmos , Female , Humans , Male , Middle Aged , Vision Disorders , contrast medium , ethylene vinyl alcohol copolymer , adult , aged , Article , artificial embolization , blurred vision , brain angiography , carotid cavernous fistula , clinical article , clinical feature , computed tomographic angiography , conjunctival hyperemia , contrast enhancement , controlled study , digital subtraction angiography , diplopia , disease course , endocrine ophthalmopathy , endovascular surgery , exophthalmos , eye examination , eye movement , eye movement disorder , eye pain , female , headache , human , intraocular pressure , male , myasthenia gravis , neurologic examination , nuclear magnetic resonance imaging , ophthalmoplegia , ptosis (eyelid) , retrospective study , visual acuity , carotid cavernous fistula , complication , endovascular surgery , exophthalmos , middle aged , procedures , visual disorder