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NATIONAL CENTER FOR NEUROSURGERY

Carotid- cavernous fistula of cerebral vessels

Carotid- cavernous fistula of cerebral vessels- is acquired intracranial vascular anomaly with the emergence of communication between the internal carotid artery or one of its branches and the cavernous sinus , through which the arterial blood is discharged into the venous system. Rupture of the internal carotid artery in the cavernous sinus cavity can be associated with trauma or spontaneously occurs in atherosclerosis and hypertension , at least as a result of infectious processes , congenital malformations of the internal carotid artery. Traumatic ruptures due mainly to water hammer of blood on the wall of the artery at the time of the head injury , and - direct mechanical impact from the outside (such as a skull fracture or penetrating injury to the cranial cavity).

Arterial blood under high pressure flows into the cavernous sinus and then against the flow of venous blood in the veins draining into the sinus . The larger the fistula, the more blood enters the sinus and correspondingly less in the middle and anterior cerebral artery. Over time, blood flow is increasingly shifting towards the anastomosis through the veins draining sinus outflow is retrograde arterial blood , increases blood supply failure. Disturbed venous outflow from the stagnation of the eye socket and brain. Sam sinus significantly expanded and increased in size , compressed passing through it, the cranial nerves - III, IV, VI , and the first branch of V ( trigeminal ) nerve.

Symptoms

  •  aneurysmal noise (trains);
  •  pulsating exophthalmos;
  •  expansion and pulsation of face and cranial vault veins;
  •  stagnation of blood in the eyeball, conjunctival edema (chemosis);
  •  veins, blood stasis and blood vessels of the retina;
  •  an increase in intraocular pressure;
  •  violation of the mobility of the eyeball;
  •  diplopia;
  •  drooping of the upper eyelid (ptosis).

Methods of treatment

  •  Endovascular treatment of carotid-cavernous fistula