Endovascular management of dural fistulas into the cavernous sinus: A systematic review

Background: Dural fistula to the cavernous sinus (DFCS) is an infrequent pathology that consists in the anomalous communication between the meningeal branches of the internal carotid artery (ICA) and/or the external carotid artery (ECA) and the cavernous sinus.Aim: To perform a systematic review to evaluate clinical and imaging findings in DFCS, and current indications for treatment.Methods: A literature search was performed in several medical databases using the keywords “intracranial dural fistula”, “carotid-cavernous fistula”, “endovascular treatment”, associated with “outcome”; resulting articles were assessed by considering factors such as: number of patients treated, type of material used, complications, and type of image technique used for diagnosis.Results: 33 articles were selected, yielding: clinical and imaging: The symptoms are basically related to the type of venous drainage of the fistula. The combination of ocular symptoms and tinnitus is highly suggestive of DFCS. Ocular symptoms are found in 80-97% of patients, while the tinnitus is present in up to 50% of cases. The imaging method for initial assessment of the DFCS is the magnetic resonance imaging. Digital subtraction angiography is the method of choice to determine adequately the precise angioarchitecture of the injury and its drainage. This data is of vital importance in future decision making. Treatment: Currently are considered as indications for the management of DFCS: 1) rapidly progressive deterioration of visual function, 2) angiographic evidence of abnormal cortical venous drainage, 3) the hypoxic consequences in retina and optic nerve, and 4) ischemic keratitis; the most suitable materials for embolization of the DFCS are CA and PAP.Conclusion: DFCS stills being an uncommon cerebrovascular condition, with good outcomes from endovascular treatment

State of the art: noninvasive imaging and management of neurovascular trauma

Neurotrauma represents a significant public health problem, accounting for a significant proportion of the morbidity and mortality associated with all traumatic injuries. Both blunt and penetrating injuries to cervicocerebral vessels are significant and are likely more common than previously recognized. Imaging of such injuries is an important component in the evaluation of individuals presenting with such potential injuries, made all the more important since many of the vascular injuries are clinically silent. Management of injuries, particularly those caused by blunt trauma, is constantly evolving. This article addresses the current state of imaging and treatment of such injuries

Unique Venous Drainage of a Sphenoid Wing Dural Arteriovenous Fistula with Ocular Symptoms

Background: Dural arteriovenous fistulas (DAVFs) presenting with ocular symptoms, such as exophthalmos and chemosis, are commonly situated in the cavernous sinus (CS). DAVFs at the sphenoid wing with a drainage route into the superior orbital vein (SOV) should be considered as one of the differential diagnoses of ocular symptoms. Case Description: A 41-year-old woman presented with progressive left-sided chemosis and proptosis after left pulsating tinnitus that disappeared spontaneously. Cerebral angiography showed that the fistula was situated along the inferior edge of the superior orbital fissure on the greater sphenoid wing and drained solely into the SOV without flowing into the CS that caused ocular symptoms. Transvenous selective catheterization was performed via the facial vein and SOV. The fistula was then embolized using detachable coils. Conclusions: After embolization, the ocular symptoms resolved, and the patient was discharged without neurologic deficit. Herein, we discuss the developmental mechanism of the unique drainage pattern, including the clinical symptoms and anatomic features of greater sphenoid wing DAVFs. © 2016 Elsevier Inc.Embargo Period 12 month

Case report: Delayed quadriplegia from traumatic carotid cavernous fistula: a rare case with perimedullary venous drainage

BackgroundCarotid cavernous fistula (CCF) refers to the abnormal arteriovenous communication between the carotid system at the skull base and the sphenoid cavernous sinus, which is caused by trauma in almost 75% of cases. The drainage of venous blood to the spinal cord represents a distinctive mechanism, which is commonly observed in dural arteriovenous fistula (DAVF), and typically manifests clinically as progressive myelopathy. However, it is a rare occurrence in clinical practice that traumatic carotid cavernous fistula (TCCF) causes delayed quadriplegia through perimedullary venous drainage.Case presentationWe report the case of a 29-year-old male patient who was admitted to the hospital with a sudden onset of headache and quadriplegia. The patient had previously lost his right eye in a traffic accident 5 years ago. Cerebral angiography showed a high-flow direct CCF on the right side, accompanied by obvious drainage of cerebellar and perimedullary veins. We successfully performed coil embolization for the CCF, and the symptoms of the patient gradually improved after the operation. During follow-up at sixth-months, the patient regained the ability to walk independently.ConclusionWe experienced a rare case of TCCF with quadriplegia. Utilizing coil embolization, we achieved successful improvement in the patient’s condition. However, the mechanism and the best treatment of CCF drainage through the perimedullary vein are still unclear. We need to further explore the pathophysiological information of CCF venous drainage

The History and Development of Endovascular Neurosurgery

Endovasuclar neurosurgery, neuroendovascular surgery and neurointervention are all defined as endovascular diagnosis and treatment of vascular lesions involving the brain and spinal cord using catheters in the DSA (digital subtraction angiography) unite. Based on literature evidences, the field of endovascular neurosurgery has evolved rapidly and successfully over the past half century and has resulted in effective endovascular therapies for carotid-cavernous fistulas (CCFs), intracranial aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistulas, atherosclerosis of cerebral arteries, acute stroke, carotid artery disease, and vascular tumors of the head, neck, and spinal vascular malformations and tumors. The scope of practice of neurovascular endovascular surgery has become complex, requiring training in specific skill sets and techniques. The evolution of the neuroendovascular field has resulted in the development of program requirements for residency or fellowship education in endovascular neurosurgery

Clinical, radiological and histological characteristics of orbital lesions and treatment options: a study of 132 cases

A retrospective study of all orbital lesions, with exclusion of endocrine orbitopathy, which were treated in the University Clinic of Ophthalmology Rostock from the year 1993 to the year 2008. A pathophysiological and anatomical classification of inflammatory, neoplastic, vascular and degenerative lesions was made and treatment outcomes were analysed with reference to the literature.Eine retrospektive Studie aller orbitaler Läsionen (Fälle von endokriner Orbitopathie wurden ausgeschlossen), die im Zeitraum 1993-2008 in der Klinik für Augenheilkunde der Universität Rostock behandelt wurden. Eine pathophysiologische und anatomische Klassifikation der inflammatorischen, neoplastischen, vaskulären und degenerativen Läsionen wurde gemacht und die Therapieergebnisse wurden in Bezug auf die entsprechende Literatur analisiert

Clinical profile of orbital apex syndrome

AIM OF THE STUDY: To describe the clinical features and management of patients with orbital apex syndrome. METHODS: Patients with orbital apex syndrome including cavernous sinus and superior orbital fissure syndrome presenting to our clinic between January and December 2012 were analysed prospectively. Detailed history, clinical, neuro ophthalmological evaluation, blood investigations and neuroimaging was done for all patients. RESULTS: 42 patients with mean age 49.21 yrs were included in the study. 20 male and 22 female patients. 40 had unilateral, 2 had bilateral involvement. Most common presentation was double vision and ocular pain seen in 22. Optic nerve involvement was seen in 19 patients. The etiology was inflammatory in 33, traumatic in 2, infectious in 3, neoplastic in 4 (of which 2 were biopsied). Patients with inflammatory etiology showed good response to steroids. Those with neoplasia were referred to NT/Neurosurgeon/oncologist for further management. CONCLUSION: Detailed history with review of systems is important in narrowing the differential diagnosis in patients with multiple cranial nerve palsies. Management is by treating the underlying cause and requires multidisciplinary approach

Trends in Cerebrovascular Surgery and Interventions

This is an open access proceeding book of 9th European-Japanese Cerebrovascular Congress at Milan 2018. Since many experts from Europe and Japan had very important and fruitful discussion on the management of Cerebrovascular diseases, the proceeding book is very attractive for the physician and scientists of the area