Barbara Albuquerque Morais1, Vitor Nagai Yamaki2, Jose Guilherme Mendes Pereira Caldas3, Wellingson Silva Paiva2, Hamilton Matushita2, Manoel Jacobsen Teixeira2. 1. Department of Neurosurgery, School of Medicine, University of Sao Paulo, Rua Dr Eneas de Carvalho, Street Eneas de Carvalho, 155, Pinheiros, Sao Paulo, SP, Brazil. babyamorais@gmail.com. 2. Department of Neurosurgery, School of Medicine, University of Sao Paulo, Rua Dr Eneas de Carvalho, Street Eneas de Carvalho, 155, Pinheiros, Sao Paulo, SP, Brazil. 3. Department of Endovascular Neurosurgery, School of Medicine, University of Sao Paulo, Rua Dr Eneas de Carvalho, 155, Pinheiros, Sao Paulo, SP, Brazil.
Abstract
BACKGROUND: Carotid-cavernous fistula (CCF) is a shunt between the carotid artery and the cavernous sinus. Traumatic CCFs are diagnosed in 0.2% of head traumas being only 4.6% of the pediatric population. Classified by Barrow in 1985, type A CCF is the most frequent, occurring in 75% of cases. Type A is characterized by direct and high-flow CCF that generally can occur as a result of traumatic injury or rupture of an intracavernous aneurysm. CASE PRESENTATION: The subject was an 8-year-old boy with penetrating trauma to his left eye. During the initial evaluation, a computed tomography (CT) scan was unremarkable, and after relief of symptoms, the patient was discharged. Seven days later, he developed grade I proptosis, conjunctival chemosis, ophthalmoplegia (III, IV, and VI cranial nerve palsies), and left-sided ptosis and mydriasis. Arteriography confirmed a post-traumatic CCF, and the patient was treated with an endovascular detachable balloon. CONCLUSION: CCF should be suspected in craniofacial traumas with ocular symptoms. The presence of a skull base fracture on CT is a poor predictor of CCF associated with head trauma. Early diagnosis and treatment can prevent permanent neurological deficits and unfavorable outcomes.
BACKGROUND: Carotid-cavernous fistula (CCF) is a shunt between the carotid artery and the cavernous sinus. Traumatic CCFs are diagnosed in 0.2% of head traumas being only 4.6% of the pediatric population. Classified by Barrow in 1985, type A CCF is the most frequent, occurring in 75% of cases. Type A is characterized by direct and high-flow CCF that generally can occur as a result of traumatic injury or rupture of an intracavernous aneurysm. CASE PRESENTATION: The subject was an 8-year-old boy with penetrating trauma to his left eye. During the initial evaluation, a computed tomography (CT) scan was unremarkable, and after relief of symptoms, the patient was discharged. Seven days later, he developed grade I proptosis, conjunctival chemosis, ophthalmoplegia (III, IV, and VI cranial nerve palsies), and left-sided ptosis and mydriasis. Arteriography confirmed a post-traumatic CCF, and the patient was treated with an endovascular detachable balloon. CONCLUSION: CCF should be suspected in craniofacial traumas with ocular symptoms. The presence of a skull base fracture on CT is a poor predictor of CCF associated with head trauma. Early diagnosis and treatment can prevent permanent neurological deficits and unfavorable outcomes.
Authors: Yelin Yang; Mustafa Kapasi; Nishard Abdeen; Marlise P Dos Santos; Michael D O'Connor Journal: Can J Ophthalmol Date: 2015-08 Impact factor: 1.882