WordNet

being or suggesting a cavern; "vast cavernous chambers hollowed out of limestone"
of or relating to either of the two major arteries supplying blood to the head and neck
an abnormal passage leading from a suppurating cavity to the body surface (同)sinus

PrepTutorEJDIC

ほら穴の多い / ほら穴のような
頚(けい)動脈 / 頚動脈の
瘻(ろう)菅(長い菅状になった潰瘍)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/31 23:51:03」(JST)

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Contributors

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 ^[1]

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) ^[1]

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.^[2]^[3]^[4]

External links

Carotid Cavernous Fistula CT and MRI images

References

^ ^a ^b Thinda, S; Melson, MR; Kuchtey, RW (Jul 28, 2012). "Worsening angle closure glaucoma and choroidal detachments subsequent to closure of a carotid cavernous fistula.". BMC ophthalmology 12: 28. doi:10.1186/1471-2415-12-28. PMC 3412712. PMID 22839357.
^ Ong, CK; Wang, LL; Parkinson, RJ; Wenderoth, JD (2009). "Onyx embolisation of cavernous sinus dural arteriovenous fistula via direct percutaneous transorbital puncture". Journal of Medical Imaging and Radiation Oncology 53 (3): 291–5. doi:10.1111/j.1754-9485.2009.02086.x. PMID 19624295.
^ Bhatia, Kartik D; Wang, Lily; Parkinson, Richard J; Wenderoth, Jason D (2009). "Successful Treatment of Six Cases of Indirect Carotid-Cavernous Fistula with Ethylene Vinyl Alcohol Copolymer (Onyx) Transvenous Embolization". Journal of Neuro-Ophthalmology 29 (1): 3–8. doi:10.1097/WNO.0b013e318199c85c. PMID 19458567.
^ Nadarajah, M.; Power, M.; Barry, B.; Wenderoth, J. (2011). "Treatment of a traumatic carotid-cavernous fistula by the sole use of a flow diverting stent". Journal of NeuroInterventional Surgery 4 (3): e1. doi:10.1136/neurintsurg-2011-010000. PMID 21990483.

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. 成人における嚥下性肺炎 aspiration pneumonia in adults
4. 成人における頭蓋骨骨折 skull fractures in adults
5. 中枢神経系の血管奇形 vascular malformations of the central nervous system

English Journal

Transvenous approach to carotid-cavernous fistula via facial vein cut down.

Thiex R1, Gross BA2, Gupta R3, Wyers MC4, Frerichs KU5, Thomas AJ6.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2014 Jul;21(7):1238-40. doi: 10.1016/j.jocn.2013.11.011. Epub 2013 Dec 7.
Endovascular access to carotid-cavernous sinus fistulae (CCF) can be obtained through a transfemoral approach to the inferior petrosal sinus (IPS) or superior ophthalmic vein (SOV). If the transfemoral approach cannot be utilized, direct surgical exposure of the SOV can provide access to the CCF. Th
PMID 24387933

Extensive basal ganglia edema caused by a traumatic carotid-cavernous fistula: a rare presentation related to a basal vein of Rosenthal anatomical variation.

Ract I1, Drier A, Leclercq D, Sourour N, Gabrieli J, Yger M, Nouet A, Dormont D, Chiras J, Clarençon F.
Journal of neurosurgery.J Neurosurg.2014 Jul;121(1):63-6. doi: 10.3171/2014.1.JNS132016. Epub 2014 Feb 14.
The authors report a very rare presentation of traumatic carotid-cavernous fistula (CCF) with extensive edema of the basal ganglia and brainstem because of an anatomical variation of the basal vein of Rosenthal (BVR). A 45-year-old woman was admitted to the authors' institution for left hemiparesis,
PMID 24527815

Transvenous embolization of a carotid cavernous fistula complicated by a hematoma at the tentorial edge.

Baharvahdat H1, Shabestari MM2, Zabihyan S3, Etemadresaei H3, Blanc R4, Piotin M4.
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.Interv Neuroradiol.2014 Jun 30;20(3):301-3. doi: 10.15274/NRJ-2014-10036. Epub 2014 Jun 17.
Indirect (dural) carotid cavernous fistulae are generally treated by endovascular surgery primary transvenous embolization that is safe and effective. We describe here a case of a left indirect carotid cavernous fistula that presented with proptosis and eye redness. The patient underwent transvenous
PMID 24976092

Japanese Journal

巨大網膜色素上皮裂孔を併発した頸動脈海綿静脈洞瘻の1例 (特集第64回日本臨床眼科学会講演集(3))

魚谷瞳,山崎厚志,魚谷竜 [他]
臨床眼科 65(5), 705-710, 2011-05
NAID 40018862521

症例糖尿病患者に認められた外転神経麻痺が頸動脈海綿静脈洞瘻によるものであった1例

金井真,清水洋
内科 107(4), 750-752, 2011-04
NAID 40018771213

Related Pictures

★リンクテーブル★

リンク元	「頚動脈海綿静脈洞瘻」「CCF」
拡張検索	「traumatic carotid cavernous fistula」「carotid-cavernous fistula」
関連記事	「cavernous」「carotid」

「頚動脈海綿静脈洞瘻」

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

　　[★]

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。