• 대한두개안면성형외과학회지
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• 제11권2호
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• pp.116-119
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• 2010

Purpose: Arteriovenous fistulas that involve the cavernous sinus often produce ophthalmologic symptoms and signs. Transvenous endovascular access is the method of choice for a carotid-cavernous sinus fistula. The superior ophthalmic vein is a safe and reasonable alternative route for the transvenous embolization of carotid-cavernous sinus fistula. We report a case of the embolization of a carotid-cavernous sinus fistula using the superior ophthalmic vein approach. Methods: A 58 year old female had conjunctival congestion, periocular pain and diplopia with a 2 month duration. Diagnostic orbital CT, brain MRI and cerebral angiography revealed a carotid-cavernous sinus fistula. The fistula occlusion was treated by coil embolization using the superior ophthalmic vein approach. Results: The initial presenting symptoms, conjunctival congestion, periocular pain and diplopia, decreased after surgery. Coil embolization via the superior ophthalmic vein approach was difficult because of the venous tortuosity and friability. During the follow up period, the patient was in a good condition without complications. Conclusion: Surgical exposure of the superior ophthalmic vein provides direct venous access to the cavernous sinus as well as an effective and safe treatment approach. The cooperation of the plastic surgeon and interventionist is a factor in successful treatment.

• 대한두개안면성형외과학회지
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• 제20권1호
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• pp.44-47
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• 2019

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotid-cavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7-8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권2호
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• pp.243-248
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• 2000

Carotid cavernous sinus fistula(CCSF) is an abnormal communication at the base of the skull between the internal carotid artery and the cavernous sinus. Fistula is almost associated with extensive facial trauma as a result of direct or indirect forces. Most fistulas of traumatic origin develop as a result of fractures through the base of the skull, which cause the laceration of the internal carotid artery near the cavernous sinus. The signs and symptoms of CCSF are pulsating exophthalmosis, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia and ophthalmoplegia. Angiography reveals a definite CCSF and a detachable balloon embolization is known to be the treatment of choice. Even though carotid cavernous sinus fistula is an uncommon complication after orthognathic surgery, several cases of CCSF due to congenital anomalies, pre-existing aneurysms and abnormally thickened maxillary posterior wall have been reported in the literature. We have experienced a case of CCSF after Le Fort I osteotomy for maxillary advancement in skeletal class III patient and the cause, pathogenesis, diagnosis and treatment of this case.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권2호
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• pp.100-104
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• 1993

저자들은 두개저 골절을 동반하지 않은 단순 안면골 골절환자에서 본과에서 안면골 정복 수술후 발현한 외상성 경동맥해변동루 환자를 신경외과에 의뢰하여 분리풍선술식으로 처치한 후 현저한 임상적 증상의 개선을 가져왔고 12개월간 관찰시 다른 합병증도 유발되지 않았다. 외상성 경동맥해면동루는 두경부 손상시 매우 드물게 발생되는 심각한 합병증으로 임상증상의 복잡성 때문에 혼동하기 쉬으므로 Neurosurgeon과 협조하여 조기에 정확한 진단과 적절한 치료가 이루어지는 것이 바람직하다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권1호
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• pp.226-230
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• 1989

As carotid-cavernous fistula is the major complication that can be occurred uncommonly after maxillofacial injuries, it is abnormal arteriovenous communication between cavernous sinus and internal carotid artery. Such an arteriovenous communication is most often the result of injuries, but need not be associated with bony fracture. It usually begins soon after an injury, but it may be delayed for as long as several months. It begins undramatically with eye pain, headache and slow protrusion of eye ball. A bruit may be heard above the eye with stethoscope. Close examination will reveal dilatation of superficial veins of the eyelid and forehead and periorbital edema. There will be complete or partial ophthalmoplesia of the affected eye. Compression of the common carotid artery on the ipsilateral side will reduce or obliterate the bruit. The lesion in the cavernous sinus is them demonstrable by angiography.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.89-93
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• 2017

Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.818-826
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• 2021

Objective : The widely accepted treatment option of a traumatic carotid cavernous fistula (TCCF) has been detachable balloon or coils based fistula occlusion. Recently, covered stent implantation has been proving an excellent results. The purpose of this study is to investigate our experiences with first line choice of covered stent implantation for TCCF at level 1 regional trauma center. Methods : From November 2004 to February 2020, 19 covered stents were used for treatment of 19 TCCF patients. Among them, 15 cases were first line treatment using covered stents. Clinical and angiographic data were retrospectively reviewed. Results : Procedures were technically successful in all 15 cases (100%). Immediate angiographic results after procedure were total occlusion in 12 patients (80%). All patients except two expired patients had image follow-up (mean 15 months). Recurred symptomatic three patients underwent additional treatments and achieved complete occlusion. Mean clinical follow-up duration was 32 months and results were modified Rankin Scale 1-2 in five, 3-4 in five, and 5 in three patients. Conclusion : The covered stent could be considered as fist line treatment option for treating TCCF patients especially in unstable vital sign. Larger samples and expanded follow-up are required to further develop their specifications and indications.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.791-793
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• 2015

• 대한영상의학회지
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• 제84권1호
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• pp.226-239
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• 2023

목적 뇌동정맥루(arteriovenous fistula; 이하 AVF), 뇌동정맥기형(arteriovenous malformation; 이하 AVM), 경동맥해면정맥동루(carotid-cavernous sinus fistula; 이하 CCF) 등 뇌동정맥단락을 진단하는 데 있어서, T2 강조영상(T2-weighted imaging; 이하 T2WI)과 자화율 강조영상(susceptibility-weighted imaging; 이하 SWI)의 민감도를 비교하고, 단일 에코(single-echo) SWI(이하 s-SWI)와 다중 에코(multi-echo) SWI (이하 m-SWI)의 전반적인 영상 질을 비교하고자 하였다. 대상과 방법 2016년부터 2021년까지 뇌혈관조영술로 입증된 뇌동정맥단락을 조사하였다. 뇌동정맥단락에 대한 T2WI와 SWI의 민감도를 McNemar's Test를 이용하여 비교하였다. s-SWI와 m-SWI의 영상 질을 나쁨, 보통, 좋음으로 분류하고 Fisher's exact test를 이용하여 그 비율을 비교하였다. 결과 총 24명의 환자(중위 연령: 61세, 여성: 12명, 남성: 12명)가 연구에 포함되었다. 그중 4명은 s-SWI와 m-SWI 두 가지의 SWI로, 나머지 20명은 이 중 한 가지의 SWI로 검사하였다. 10명은 AVF, 11명은 AVM, 3명은 CCF로 진단되었고, 이와 같은 뇌동정맥단락에 대해, SWI는 T2WI 보다 유의하게 높은 민감도를 보였다(82.1% vs. 53.6%, p = 0.013). m-SWI는 s-SWI 보다 좋은 영상 질의 비율이 유의하게 높았다(83.3% vs. 25.0%, p = 0.009). 결론 SWI는 T2WI 보다 뇌동정맥단락을 더 민감하게 진단해 낼 수 있었으며, m-SWI는 s-SWI보다 혈관질환을 평가하는데 더 좋은 영상 질을 보였다.

• Journal of Korean Neurosurgical Society
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• 제63권4호
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• pp.532-538
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• 2020

Traumatic arteriovenous fistulas (AVFs) involving the external carotid artery are exceedingly rare in young adults. Since an AVF is the most common life-threatening cause for pulsatile tinnitus (PT), meticulous evaluation and treatment of patients with PT is crucial. Here, we present two traumatic AVF cases treated with coil embolization leading to no residual fistulous connections followed by an immediate and complete resolution of PT. A 20-year-old man developed left ear tinnitus three months after a traumatic brain injury involving the right temporal bone fracture. Cerebral angiography demonstrated an enlarged left middle meningeal artery (MMA) and a fistular point at the posterior branch of the MMA draining to the middle meningeal vein (MMV) and the left pterygoid plexus, suggesting an AVF. Another 18-year-old girl developed left tinnitus, left exophthalmos, and conjunctival injection 6 months after a traffic accident involving no demonstrable abnormal findings in the radiologic exam. Magnetic resonance angiography demonstrated a markedly dilated left MMA draining to the MMV, left cavernous sinus, and left superior ophthalmic vein. In both cases, coil embolization was performed with total obliteration of the fistular point.