Large cavernous? sinus with signal voids ( t1w) .
TI ( C) :
Enlarged enhancing cavernous? sinus? and SOV.
Adjacent or diffuse dural enhancement .
MRA :
Increased flow related? signal in the? CS .
Increased signal void? in CS : Due to? increased turbulence
Flow in SOV and /or trans-sellar collaterals?
?
Diagnosis: Carotico Carvernous fistula
?
Discussion:
?Blood from cavernous ICA? to CS ..SOV and petrosal sinuses.
?Reflux from cerebral cortical veins occurs when SOV/IOV and petrosal sinuses? cannot handle large blood volume ?increased risk of SAH .
?
Etiology & Types??Skull base fracture? commonest .
?Ruptured cavernous ICA aneurysm .
?Younger individuals (prone to trauma ) average age ( 37 years) . Gender : male .
?Individual? with collagen vascular disorders
?Most tears? involve the proximal horizontal or vertical cavernous ICA .
?Type A : Direct communication between ICA? and cavernous? sinus
?Type B-D : Indirect communications? between the meningeal/dural branches of ICA/ECA and cavernous sinus
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Clinical Findings??Symptoms develop? either spontaneously? or days / wks after trauma
Bruit ( 50%) , pulsating exophthalmos , orbital edema / erythema , decrease vision, glaucoma , headache . Severe rapid vision loss ,SAH , Focal deficits ( CN 3-6). ( these findings may? be unilateral / bilateral)
?
Treatment??Spontaneous? thrombosis? rare , progresses if untreated .
?ICA / JUGULAR vein compression? ..only for small CCF
?Embolization (coiling or balloon) : Trans-arterial or transvenous .
?Surgery / Gamma knife
?
Dr Ritesh Mahajan
