Abstract and Introduction
Carotid-cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Fractures or the shearing forces of severe head trauma may cause the internal carotid artery to be torn from its points of dural attachment and rupture, with resultant direct flow into the cavernous sinus. Current treatment options for carotid-cavernous sinus fistulae are surgery and coil embolization, with embolization being the most common. Clinicians and nurses treating patients with these injuries should have an understanding of this vascular entity, because prompt intervention helps to prevent permanent disability and improve patient outcomes. This case study reports the diagnosis and treatment of a carotid-cavernous sinus fistula that developed several months after a traumatic head injury.
Traumatic carotid-cavernous sinus fistulae (CCSF) are uncommon, yet dangerous, vascular anomalies in the skull base that result from craniomaxillofacial trauma (Fattahi et al., 2003). Fracture or shearing forces of severe head trauma may cause the internal carotid artery (ICA) to detach from its point of dural attachment and rupture, with resultant direct flow into the cavernous sinus (Larsen, Higashida, & Connors III, 1999). Leaking of arterial blood into the cavernous sinus alters normal blood flow. Clinical presentation is related to the size, location, and route of venous drainage, as well as the presence of arterial and venous collateral vessels (Larsen et al., l999). Elevated pressure in veins draining the orbit can produce pulsatile tinnitus and ophthalmic signs and symptoms that include proptosis, chemosis, diplopia, temporal bruit, impaired ocular movements, and visual loss (Bosley & Schatz, 1983).
Current treatment options for CCSF are surgery or coil embolization. Coil embolization is the most commonly used treatment (Hara et al., 2002). In the past, endovascular occlusion using detachable balloons was a common treatment for this condition. However, the manufacture of these balloons has ceased. The treatment of intracranial aneurysms and other neurovascular conditions advanced significantly with the development of Guglielmi detachable coils (Boston Scientific/Neurovascular, Fremont, CA; Bendok, Hanel, & Hopkins, 2003).
Coil embolization is a minimally invasive endovascular alternative to cranial surgery for CCSF. Clinicians and nurses treating patients with head injuries should recognize the clinical features of this neurovascular condition, because prompt intervention may prevent permanent disability and improve patient outcomes. This article present an overview of the diagnosis, treatment, and postembolization management of a patient with a CCSF.
J Neurosci Nurs. 2005;37(4):200-202, 210. © 2005 American Association of Neuroscience Nurses
Cite this: Carotid-Cavernous Sinus Fistula: A Case Study - Medscape - Aug 01, 2005.
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