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Research ArticleNeurointervention

Ruptured Cavernous Sinus Aneurysms Causing Carotid Cavernous Fistula: Incidence, Clinical Presentation, Treatment, and Outcome

W.J. van Rooij, M. Sluzewski and G.N. Beute
American Journal of Neuroradiology January 2006, 27 (1) 185-189;
W.J. van Rooij
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M. Sluzewski
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G.N. Beute
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    Fig 1.

    Patient 6. Ruptured left cavernous sinus aneurysm in a 70-year-old woman with bilateral exophthalmus, ophthalmoplegia, and decreased vision.

    A, Frontal view of left internal carotid artery angiogram. High-flow CCF with venous drainage to both cavernous sinuses, superior ophthalmic veins, and inferior petrosal sinuses. There is some cortical venous drainage, but no filling of intracranial vessels.

    B, Right carotid angiogram demonstrates overflow to the left side and some contribution to the CCF.

    C, Early arterial phase shows the aneurysm.

    D, Coiling with balloon protection of the carotid artery.

    E and F, Closure of the CCF with patency of the internal carotid artery.

  • Fig 2.
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    Fig 2.

    Patient 9. Ruptured right cavernous sinus aneurysm in a 74-year-old woman with bilateral exophthalmus, ophthalmoplegia, and decreased vision.

    A and B, Frontal (A) and lateral (B) view of right internal carotid artery angiogram. Principal venous drainage to both cavernous sinuses and superior ophthalmic veins. There is some cortical venous drainage.

    C and D, Arterial (C) and venous (D) phase of left internal carotid angiogram during test occlusion of the right internal carotid artery. Synchronous opacification of cortical veins in both hemispheres indicates tolerance to permanent occlusion.5

    E, Occlusion of the ruptured aneurysm, including the internal carotid artery, with coils.

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    Fig 3.

    Patient 4. CCF in a 61-year-old woman with bilateral exophthalmus, ophthalmoplegia, and decreased vision.

    A, Lateral view of left internal carotid angiogram shows CCF with principal venous drainage to both cavernous sinuses and superior ophthalmic veins. There is some cortical venous drainage.

    B, Early arterial phase shows small cavernous aneurysm.

    C and D, Selective occlusion of the aneurysm with a detachable balloon.

    E and F, Follow-up angiogram after 4 months shows reopening and enlargement of the aneurysm, subsequently occluded with coils.

Tables

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  • Clinical presentation, treatment and outcome in 11 patients with ruptured cavernous sinus aneurysms causing CCF

    Patient No./ Gender/Age (y)PresentationDiagnosisPrincipal Venous DrainageTest OcclusionTreatmentOutcome; Duration of Follow-up in Months
    1/F/77Bilateral exophthalmus and ophthalmoplegia, vision 0.1 bilateral, pulsatile bruitHigh-flow left CCFBilateral superior ophthalmic vein, minor cortical venous drainage−Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 9 mo
    2/F/75Left exophthalmus and ophthalmoplegia, pulsatile bruit, decreased visionIntermediate-flow left CCFLeft superior ophthalmic vein, no cortical venous drainage−Coiling aneurysm ×2Complete recovery; 72 mo
    3/F/60Left hemiplegia and aphasia, bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitHigh-flow right CCFBilateral superior ophthalmic vein, major cortical venous drainage+Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 6 mo
    4/F/61Bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitIntermediate-flow left CCFBilateral superior ophthalmic vein, minor cortical venous drainage+Balloon occlusion aneurysm, later coiling pseudo-aneurysmComplete recovery; 18 mo
    5/M/27Left abducens palsy, decreased vision, pulsatile bruitLow-flow left CCFLeft superior ophthalmic vein, left petrosal sinus, no cortical venous drainageNot doneSpontaneous closure, coiling aneurysm ×2Complete recovery; 24 mo
    6/F/70Bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitHigh-flow left CCFBilateral superior ophthalmic vein, minor cortical venous drainage+Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 34 mo
    7/F/51Right exophthalmus and ophthalmoplegia, pulsatile bruitHigh-flow right CCFRight superior ophthalmic vein, no cortical venous drainage+Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 28 mo
    8/M/58Left exophthalmus, left abducens palsy, pulsatile bruitLow-flow left CCFLeft superior ophthalmic vein, no cortical venous drainage+Spontaneous closure CCF, carotid occlusionRemaining VI palsy; 4 mo
    9/F/74Bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitIntermediate-flow right CCFBilateral superior ophthalmic vein, minor cortical venous drainage+Coiling aneurysm + carotid arteryRemaining right VI palsy; 7 mo
    10/M/65Left exophthalmus and ophthalmoplegia, vision 0 left, pulsatile bruitHigh-flow left CCFLeft superior ophthalmic vein+Coiling aneurysm + carotid arteryEnucleation left eye; 38 mo
    11/F/59Pulsatile bruit, left temporal hemorrhage ×2High-flow right CCFMajor cortical venous drainageNot doneNoneDeath
    • Note:—+ indicates tolerance; −, nontolerance.

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American Journal of Neuroradiology: 27 (1)
American Journal of Neuroradiology
Vol. 27, Issue 1
January, 2006
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Cite this article
W.J. van Rooij, M. Sluzewski, G.N. Beute
Ruptured Cavernous Sinus Aneurysms Causing Carotid Cavernous Fistula: Incidence, Clinical Presentation, Treatment, and Outcome
American Journal of Neuroradiology Jan 2006, 27 (1) 185-189;

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Ruptured Cavernous Sinus Aneurysms Causing Carotid Cavernous Fistula: Incidence, Clinical Presentation, Treatment, and Outcome
W.J. van Rooij, M. Sluzewski, G.N. Beute
American Journal of Neuroradiology Jan 2006, 27 (1) 185-189;
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  • Mid- and long-term outcomes of carotid-cavernous fistula endovascular management with Onyx and n-BCA: experience of a single tertiary center
  • Cavernous Carotid Aneurysms in the Era of Flow Diversion: A Need to Revisit Treatment Paradigms
  • Multimodal endovascular therapy of traumatic and spontaneous carotid cavernous fistula using coils, n-BCA, Onyx and stent graft
  • Endosaccular treatment of 113 cavernous carotid artery aneurysms
  • Placement of Covered Stents for the Treatment of Direct Carotid Cavernous Fistulas
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