| Abstrakt: |
Introduction: The carotid-cavernous fistula (CCF) is a pathological communication between an artery and a venous sinus or meningeal veins. Direct arterial blood flow to the veins leads to specific pathophysiological changes and associated with them clinical manifestations, which vary from a benign course with spontaneous remission to a fatal outcome due to cerebral hemorrhage. The treatment of CCF is complex (conservative, endovascular - transarterial or transvenous embolization, surgical, radiosurgical) and, in higher-flow fistulas, is associated with a high risk of recurrence. Conventional angiography, CT angiography, MRI angiography, which are invasive, time-consuming and associated with additional risk studies, are standardly used to monitor the treatment result. Aim: In the present report, we would like to present the capabilities of color-coded duplex sonography (CCDS) as a non-invasive, convenient, rapid, and effective method for assessing CCF in outpatient settings. Material and methods: We present a clinical case of a 40-year-old female patient with complaints of conjunctival injection, eye edema, double vision, nausea and vomiting, progressively worsening after a 1-month-old trauma (traffic accident - being hit by a tram as a pedestrian). Initially, the patient was hospitalized as an emergency and treated conservatively: skull base fracture; subarachnoid hemorrhage on the left fronto-temporo-parietal and right frontal areas; intracerebral hemorrhage in the left frontal cranial fossa; subdural hematoma on the left temporo-occipital region; fracture of the left humerus proximally and left processus mastoideus. Due to these complaints the patient was hospitalized in the Neurosurgery clinic at Acibadem City Clinic MHAT Tokuda for imaging and subsequent treatment. Results: The performed CT and MRI angiographies showed the presence of CCF on the left in the area of the C4 segment of the left ICA with high arterial flow (type I Barrow, Cognard II). The patient underwent endovascular implantation of a flow diverter. In the course of follow-up by CCDS, persistence of arterial blood flow in the ophthalmic veins and progressively rising intraocular pressure (monitored by an ophthalmologist) associated with a high risk of vision loss and additional neurological deterioration were found, for which the patient underwent a secondstage coil-embolization and implantation of a second flow diverter. As part of the pre- and post-procedural assessment of the AV fistula, a transophthalmic CCDS blood flow study in the superior ophthalmic vein was used. This finding was confirmed by the conventional and MRI angiograms performed during the follow-up. Conclusions: CCDS is an effective and easy way to adequately assess hemodynamics in some cases of CCF. [ABSTRACT FROM AUTHOR] |
