carotid-cavernous sinus fistula

頚動脈海綿静脈洞瘻、頸動脈海綿静脈洞瘻

WordNet

1. commit a sin; violate a law of God or a moral law (同)transgress, trespass
2. violent and excited activity; "they began to fight like sin" (同)hell
3. estrangement from god (同)sinfulness, wickedness
4. an act that is regarded by theologians as a transgression of Gods will (同)sinning
5. the 21st letter of the Hebrew alphabet
6. being or suggesting a cavern; "vast cavernous chambers hollowed out of limestone"
7. of or relating to either of the two major arteries supplying blood to the head and neck
8. an abnormal passage leading from a suppurating cavity to the body surface (同)sinus
9. any of various air-filled cavities especially in the bones of the skull

PrepTutorEJDIC

1. 〈U〉(宗教・道徳上の)『罪』 / 〈C〉(宗教・道徳上の)『罪の行為』,罪悪 / 〈C〉《特におどけて》違反(過失)の行為 / (宗教・道徳上の)おきてを破る,罪を犯す / (…に)違反(過失)をする,背く《+『against』+『名』》
2. sine
3. ほら穴の多い / ほら穴のような
4. 頚(けい)動脈 / 頚動脈の
5. 瘻(ろう)菅(長い菅状になった潰瘍)
6. 洞(どう)(骨や組織の中の穴・くぼみなど);静脈洞

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/12 14:51:43」(JST)

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Carotid-cavernous fistula
Classification and external resources
Oblique section through the cavernous sinus.
DiseasesDB	2152
eMedicine	oph/204 radio/134
MeSH	D020216

A carotid-cavernous fistula (CCF) results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. It is a type of arteriovenous fistula. As arterial blood under high pressure enters the cavernous sinus, the normal venous return to the cavernous sinus is impeded and this causes engorgement of the draining veins, manifesting most dramatically as a sudden engorgement and redness of the eye of the same side.

Causes

Carotid cavernous fistulae may form following closed or penetrating head trauma, surgical damage, rupture of an intracavernous aneurysm, or in association with connective tissue disorders, vascular diseases and dural fistulas.

Classification

Various classifications have been proposed for CCF. They may be divided into low-flow or high-flow, traumatic or spontaneous and direct or indirect. The traumatic CCF typically occurs after a basal skull fracture. The spontaneous dural cavernous fistula which is more common usually results from a degenerative process in older patients with systemic hypertension and atherosclerosis. Direct fistulas occur when the Internal Carotid artery (ICA) itself fistulizes into the Cavernous sinus whereas indirect is when a branch of the ICA or External Carotid artery (ECA) communicates with the cavernous sinus.

A popular classification divides CCF into four varieties depending on the type of arterial supply.

Type	Description
A	Fistulous supply from the internal carotid artery
B	Supply from the dural branches of internal carotid artery
C	from meningeal branches of ext carotid artery
D	combined ICA+ECA

Presentation

dilated blood vessels in the eye in CCF

CCF symptoms include bruit (a humming sound within the skull due to high blood flow through the arteriovenous fistula), progressive visual loss, and pulsatile proptosis or progressive bulging of the eye due to dilatation of the veins draining the eye. Pain is the symptom that patients often find the most difficult to tolerate.

Patients usually present with sudden or insidious onset of redness in one eye, associated with progressive proptosis or bulging.

They may have a history of similar episodes in the past.

Diagnosis

Selective angiography of the external carotid artery showing an indirect type D right carotid cavernous fistula, filling of the cavernous sinus (arrow) and retrograde drainage into the right superior ophthalmic vein (arrowhead)

This is based on MRI scan, magnetic resonance angiography and CT scan. A cerebral digital subtraction angiography (DSA) enhances visualization of the fisula.

• CT scans show diffuse enlargement of all the extraocular muscles resulting from venous engorgement and a characteristically enlarged superior ophthalmic vein.

• Selective arteriography is used to evaluate arteriovenous fistulas.

Treatment

The mainstay of treatment for CCF is endovascular therapy. This may be transarterial (mostly in the case of direct CCF) or transvenous (most commonly in indirect CCF). Occasionally, more direct approaches, such as direct transorbital puncture of the cavernous sinus or cannulation of the draining superior orbital vein are used when conventional approaches are not possible. Spontaneous resolution of indirect fistulae has been reported but is uncommon. Staged manual compression of the ipsilateral carotid has been reported to assist with spontaneous closure in selected cases.

Direct CCF may be treated by occlusion of the affected cavernous sinus (coils, balloon, liquid agents), or by reconstruction of the damaged internal carotid artery (stent, coils or liquid agents).

Indirect CCF may be treated by occlusion of the affected cavernous sinus with coils, liquid agents or a combination of both.

External links

• Carotid Cavernous Fistula CT and MRI images

References

UpToDate Contents

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• 1. 頚動脈海綿静脈洞瘻 carotid cavernous fistulas
• 2. トロサハント症候群 tolosa hunt syndrome
• 3. 成人における頭蓋骨骨折 skull fractures in adults
• 4. 中枢神経系の血管奇形 vascular malformations of the central nervous system
• 5. 脳静脈血栓症の病因、臨床的特徴、および診断 etiology clinical features and diagnosis of cerebral venous thrombosis

English Journal

• Radiographic and clinical outcomes in cavernous carotid fistula with special focus on alternative transvenous access techniques.

• Morton RP1, Tariq F2, Levitt MR2, Nerva JD2, Mossa-Basha M3, Sekhar LN2, Kim LJ4, Hallam DK4, Ghodke BV4.
• Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2015 May;22(5):859-64. doi: 10.1016/j.jocn.2014.11.006. Epub 2015 Feb 11.
• Carotid cavernous fistulae (CCF) are dangerous entities that may cause progressive cranial neuropathy, headache and blindness. Endovascular therapy for CCF is the treatment of choice and can be accomplished with minimal morbidity, but optimal treatment strategies vary according to CCF anatomy. We ai
• PMID 25682541

• Treatment of direct carotid-cavernous fistulas with a double lumen balloon.

• Samaniego EA1, Martínez-Galdámez M2, Abdo G1.
• Journal of neurointerventional surgery.J Neurointerv Surg.2015 Apr 15. pii: neurintsurg-2015-011695. doi: 10.1136/neurintsurg-2015-011695. [Epub ahead of print]
• OBJECTIVE: To describe the treatment of direct high flow carotid-cavernous sinus fistulas (dCCFs) with the double lumen balloon Scepter C.MATERIALS AND METHODS: 7 patients with dCCFs were identified and treated with a double lumen balloon Scepter C. 5 patients had post-traumatic dCCFs and two patien
• PMID 25878067

• Integrated open surgical and endovascular embolization treatment of a paracavernous venous plexus fistula: case report.

• Dye JA1, Buchanan CC, Gonzalez NR.
• Journal of neurosurgery.J Neurosurg.2015 Apr;122(4):933-8. doi: 10.3171/2014.11.JNS14958. Epub 2014 Dec 19.
• The authors report the treatment of a rare type of dural arteriovenous fistula of the paracavernous venous plexus. These fistulas can mimic carotid-cavernous fistulas in both imaging characteristics and clinical presentation, but the anatomical differences require differences in management. The auth
• PMID 25526277

Japanese Journal

• 血管内治療で改善した頸動脈海綿静脈洞瘻の2例 (特集 第64回日本臨床眼科学会講演集(7))

• 権田 恭広,飯田 裕太郎,杤久保 哲男
• 臨床眼科 65(9), 1483-1487, 2011-09
• NAID 40019005443

• Carotid-Cavernous Fistula Caused by Rupture of Persistent Primitive Trigeminal Artery Trunk Aneurysm : Case Report

• YOSHIDA Masahiro,EZURA Masayuki,MINO Masaki
• Neurologia medico-chirurgica = 神経外科 51(7), 507-511, 2011-07-15
• … A 60-year-old female presented with a carotid-cavernous fistula (CCF) manifesting as left abducens nerve palsy. … Left internal carotid digital subtraction angiography showed a persistent primitive trigeminal artery (PPTA) near the CCF. … Super-selective angiography showed direct shunt flow between the PPTA trunk aneurysm and the left cavernous sinus. …
• NAID 10029138525

Related Links

• Carotid–Cavernous Sinus Fistula — NEJM

Images in Clinical Medicine from The New England Journal of Medicine — Carotid–Cavernous Sinus Fistula ... A 55-year-old woman with a long history of hypertension presented to the hospital with a 1-day history of periorbital ...

• Carotid Cavernous Fistula: Ophthalmological Implications

Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF can be due to a direct connection between the cavernous segment of the internal carotid ...

Related Pictures

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★リンクテーブル★

リンク元	「頚動脈海綿静脈洞瘻」「内頚動脈海綿静脈洞部」
関連記事	「cavernous」「carotid」

「頚動脈海綿静脈洞瘻」

　　[★]

英

carotid-cavernous sinus fistula, CCF, carotid cavernous fistula, CCF

同

頸動脈海綿静脈洞瘻、内頚動脈海綿静脈洞瘻？、内頸動脈海綿静脈洞瘻？

関

硬膜動静脈瘻

[show details]

頚動脈海綿静脈洞瘻 : 約 140,000 件
頸動脈海綿静脈洞瘻 : 約 97 件
内頚動脈海綿静脈洞瘻 : 約 2,210 件
内頸動脈海綿静脈洞瘻 : 約 98 件

概念

• 頚動脈、とくに内頚動脈と海綿静脈に異常交通をきたした状態(動静脈瘻)をいう。
• 一側の眼球突出、結膜の充血浮腫、心拍に一致した血管雑音が3主徴と言われている。

原因

• 頭部外傷：トルコ鞍近傍の前頭蓋骨底骨折により海綿静脈洞内で内頚動脈やその分枝が損傷受けて瘻が形成される
• 脳動脈瘤破裂：外傷などにより、海綿静脈洞内の内頚動脈に偽性動脈瘤が形成され、後日破裂して生じる。
• 動脈硬化
• 特発性

分類

• 外傷性
• 特発性

• 直接型：海綿静脈洞～内頚動脈本幹
• 間接型：海綿静脈洞～内・外頚動脈硬膜枝

病態

• 動脈血が海綿静脈洞内に直接流入するため、眼窩内の静脈圧が亢進し、拍動性眼球突出、結膜充血と結膜浮腫、眼瞼周囲の血管雑音を呈する。また、眼球運動障害、視力障害、大量の鼻出血、頭痛、眼科部痛などを呈する。症状は瘻ができた側に強く認められるが、静脈洞は左右で連絡しているため、反対側や両側に症状が出ることもある。

症状

• 複視、視力障害、眼窩部痛、頭痛

Henry Gray (1825-1861). Anatomy of the Human Body. 1918.

徴候

• 聴診：血管雑音
• 眼：眼球突出、結膜充血、結膜浮腫
• 外眼筋：外眼筋麻痺

経過

• 上記の症状が出現し、放置にて視力障害が進行する。

診断

• 脳血管アンギオ：内頸動脈と海綿静脈洞が同時期に造影される

治療

• 特発性の場合自然に閉鎖することがあるが、外傷性の場合は自然閉鎖は難しい。
• 手術療法としては、バルーンなどによる血管内治療が選択される。

国試

• 112A031：海綿静脈洞塞栓術を行う

「内頚動脈海綿静脈洞部」

　　[★]

英

carotid-cavernous sinus, carotid cavernous sinus

関

carotid-cavernous sinus fistula

「cavernous」

　　[★]

• adj.

• 空洞性の、(脳)海綿静脈洞の

関

cavitary

　 　

「carotid」

　　[★]

• adj.

• 頚動脈の、頸動脈の

関

carotid artery