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Anil Arat - One of the best experts on this subject based on the ideXlab platform.

  • retinal and choroidal optical coherence tomography findings of carotid cavernous fistula
    American Journal of Ophthalmology, 2019
    Co-Authors: Onur Inam, Yonca Ozkan Arat, Guliz Fatma Yavas, Anil Arat
    Abstract:

    Purpose To define the retinal and choroidal imaging findings of carotid cavernous fistula (CCF) including central foveal thickness, subfoveal choroidal thickness, choroidal vascularity index (CVI) parameters, and tortuosity indexes (TIs) as compared to a control group (CG). Design Cross-sectional study. Materials and Methods The spectral domain enhanced-depth imaging optical coherence tomography images of 19 eyes of 19 consecutive patients with angiographically proven CCF and 19 eyes of 19 age- and sex-matched healthy control subjects were included. The patient group was divided according to CCF venous drainage pattern as anterior (A-CCF: draining into Ophthalmic Veins) and posterior (P-CCF: not draining into Ophthalmic Veins). The clinically affected eyes of the patient group, ipsilateral to the fistula, were included in the analysis. Results There were 15 A-CCFs (78.9%) and 4 P-CCFs (21.1%). The mean SFCT of the A-CCF group (395.21 ± 111.69 μm) was significantly higher than those of the P-CCF (246.84 ± 94.12 μm) and CG groups (280.79 ± 111.36 μm) (P = .039 and P = .006, respectively). The mean CVI of the A-CCF group was significantly higher than that of the CG (68.97 ± 4.81 and 65.66 ± 3.37, respectively, P = .033). The A-CCF group had significantly higher inferior, superior, and total venous TI than the CG group (P = .001, P = .001, and P Conclusion In this first study investigating the CVI and TI in CCF patients, we demonstrated that SFCT, CVI, and TI could potentially be used to aid in the diagnosis of A-CCF.

D Kuhne - One of the best experts on this subject based on the ideXlab platform.

  • endovascular management of dural carotid cavernous sinus fistulas in 141 patients
    Neuroradiology, 2006
    Co-Authors: M Kirsch, Hans Henkes, Thomas Liebig, W Weber, J Esser, S Golik, D Kuhne
    Abstract:

    Introduction: The purpose of this study was to evaluate the single-centre experience with trans- venous coil treatment of dural carotid- cavernous sinus fistulas. Methods: Between November 1991 and De- cember 2005, a total of 141 patients (112 female) with dural carotid-cav- ernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included che- mosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the pa- tients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients com- plete filling of the cavernous sinus and the adjacent segment of the superior and inferior Ophthalmic vein with detachable coils. Results: Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cor- tical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arterio- venous shunt, no recurrence was observed. Conclusion: The transve- nous coil occlusion of the superior and inferior Ophthalmic Veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid-cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved.

Shuu-jiun Wang - One of the best experts on this subject based on the ideXlab platform.

  • Diameter of the Superior Ophthalmic Vein in Relation to Intracranial Pressure
    2015
    Co-Authors: Jiing-feng Lirng, Jong-ling Fuh, Shuu-jiun Wang
    Abstract:

    BACKGROUND AND PURPOSE: Bilateral engorged superior Ophthalmic Veins (SOV) have been reported in patients with diffuse brain swelling. We investigated the relationship between the diameter of the SOV on brain MR images and the intracranial pressure (ICP). METHODS: We reviewed the medical records of neurologic inpatients who had undergone both MR imaging of the brain and lumbar puncture. MR imaging had to have been performed before lumbar puncture, and the two studies had to have occurred within 2 days. The diameters of the SOV were measured on coronal contrast-enhanced fat-saturated T1-weighted MR images. For this, the image nearest the rear of the globe of the eye was chosen. RESULTS: Sixty-nine patients (32 male, 37 female; mean age, 46 years 19) were included. The average diameters of the SOV and the ICP were positively correlated (r 0.58, P <.001), if an SOV diameter of <1 mm was treated as 0.5 mm for calculations. In patients with increased ICP (CSF pressure>200 mm H2O), SOV diameters were larger than those of patients with a normal CSF pressure (3.0 vs 1.6 mm, P <.001). Frequencies of increased ICP were 3 % among patients with an average SOV diameter of 0.5–1 mm, 15 % for 1.5–2 mm, and 58 % for 2.5–5 mm (P <.001)

  • Collapsed superior Ophthalmic Veins in patients with spontaneous intracranial hypotension.
    Neurology, 2003
    Co-Authors: W.-t. Chen, Jong-ling Fuh, Jiing-feng Lirng, Shuu-jiun Wang
    Abstract:

    The authors measured the average diameter of bilateral superior Ophthalmic Veins (SOV) in 13 patients with spontaneous intracranial hypotension (SIH) on contrast-enhanced, coronal, T1-weighted MRI. Compared with sex- and age-matched neurology inpatients with normal CSF pressure, the SIH group had a smaller SOV diameter (0.90 vs 1.85 mm, p < 0.001), which partly reversed after treatment (1.09 vs 0.90 mm, p = 0.045, n = 7). Collapsed SOV might provide an additional MRI finding for SIH.

  • Diameter of the superior Ophthalmic vein in relation to intracranial pressure.
    AJNR. American journal of neuroradiology, 2003
    Co-Authors: Jiing-feng Lirng, Jong-ling Fuh, Shuu-jiun Wang
    Abstract:

    BACKGROUND AND PURPOSE: Bilateral engorged superior Ophthalmic Veins (SOV) have been reported in patients with diffuse brain swelling. We investigated the relationship between the diameter of the SOV on brain MR images and the intracranial pressure (ICP). METHODS: We reviewed the medical records of neurologic inpatients who had undergone both MR imaging of the brain and lumbar puncture. MR imaging had to have been performed before lumbar puncture, and the two studies had to have occurred within 2 days. The diameters of the SOV were measured on coronal contrast-enhanced fat-saturated T1-weighted MR images. For this, the image nearest the rear of the globe of the eye was chosen. RESULTS: Sixty-nine patients (32 male, 37 female; mean age, 46 years ± 19) were included. The average diameters of the SOV and the ICP were positively correlated ( r = 0.58, P 200 mm H 2 O), SOV diameters were larger than those of patients with a normal CSF pressure (3.0 vs 1.6 mm, P P CONCLUSION: This study showed that the SOV diameter, determined on the basis on MR imaging, was positively correlated with ICP. Dilatation of the SOV should alert physicians to the possibility of increased ICP.

Shervin R Dashti - One of the best experts on this subject based on the ideXlab platform.

  • transorbital endovascular embolization of dural carotid cavernous fistula access to cavernous sinus through direct puncture case examples and technical report
    Neurosurgery, 2011
    Co-Authors: Shervin R Dashti, David Fiorella, Robert F Spetzler, Felipe C Albuquerque, Cameron G Mcdougall
    Abstract:

    OBJECTIVE: We present 2 cases of carotid-cavernous fistulas that failed multiple attempts at transarterial and transvenous embolization. Direct transorbital puncture for embolization was successful in curing the fistulas. The relevant anatomy and technique are reviewed. CLINICAL PRESENTATION: The first case is a 39-year-old man who presented with a 2-month history of worsening right-sided chemosis, proptosis, double vision, and progressive right eye vision loss. The second case is a 79-year-old woman with a 5-month history of right-sided chemosis and a 1-month history of complete left ophthalmoplegia. Cerebral angiography revealed an indirect carotid-cavernous fistula (CCF) in both patients, supplied by meningeal branches of the internal and/or external carotid arteries. INTERVENTION: After multiple unsuccessful attempts at transarterial and transvenous embolization, the CCFs were accessed via direct percutaneous transorbital puncture of the inferior and superior Ophthalmic Veins, respectively. The fistulas were then successfully occluded with a combination of Onyx and detachable coils. CONCLUSION: In rare cases in which more conventional transvenous and transarterial routes to a CCF have been exhausted, direct percutaneous transorbital puncture represents a viable means of achieving catheterization of the fistulous connection. In most cases, where a prominent arterialized superior Ophthalmic vein is present, direct puncture represents a reasonable alternative to ophthalmologic cut-down procedures. Transorbital puncture of the inferior Ophthalmic vein provides a direct route to the cavernous sinus in cases where the superior Ophthalmic vein is atretic and inaccessible by direct surgical cut-down procedures.

J Sheehan - One of the best experts on this subject based on the ideXlab platform.

  • minimally invasive approaches to treating chemosis of the eyes from unusual dural arteriovenous fistulae
    Minimally Invasive Neurosurgery, 2009
    Co-Authors: W.h. Chen, C C Ting, J Sheehan
    Abstract:

    : Chemosis of the eyes is usually attributed to carotid cavernous sinus dural arteriovenous fistulae. Herein, we reviewed unusual cases in which chemosis of the eyes originated from dural ateriovenous fistulae (dAVFs) that were distinctly different from carotid cavernous sinus fistulae. Cases in which ocular symptoms were related to increased intracranial pressure either due to sinus thrombosis or cortical venous drainage without involvement of superior or inferior Ophthalmic Veins were excluded in this review. Several different types of dural AVFs were associated with chemosis, and these included dAVFs harboring a feeding artery from branches of the external carotid artery directly draining to the superior Ophthalmic vein or cavernous sinus via the superior petrous sinus, posterior fossa dAVFs draining via the inferior petrous sinus and cavernous sinus to the Ophthalmic vein, a fistula between the Ophthalmic artery or branches of the internal carotid artery and inferior Ophthalmic vein, or tentorial fistula with a drainage vein to the cavernous sinus via the vein of Galen. This study reviews the symptomatology, treatment options, and cerebrovascular abnormalities observed for these unusual dAVF's with chemosis.