AJDRAJNR - American Journal of Neuroradiology

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Coskun, O.
Right arrow Articles by Théron, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Coskun, O.
Right arrow Articles by Théron, J.

Carotid-cavernous Fistulas: Diagnosis with Spiral CT Angiography

Oguzhan Coskuna, Michèle Hamona, Guillaume Catrouxa, Lydie Gosmea, Patrick Courthéouxa and Jacques Thérona

a From the Department of Neuroradiology and Interventional Radiology, Centre Hospitalo-Universitaire, Avenue Côte de Nacre, 14033 Caen, France. Address reprint requests to Michèle Hamon, MD.



View larger version (135K):

[in a new window]
  		FIG 1. Case 1: 40-year-old man with direct, posttraumatic, right-sided CCF.

A and B, Superior view of 3D CT angiogram obtained with the volume rendering technique shows an enlarged right cavernous sinus (long arrow ) with several draining veins: large right SOV (open arrow, A), anterior intercavernous sinus (asterisk ), inferior petrous sinus (yellow arrowheads), sphenoparietal sinus (white arrowheads, A), and paracavernous sinus (red arrows).

C, DSA during embolization with selective right internal carotid artery injection shows right cavernous fistula with very high flow and multiple venous drainage channels, including large right SOV (open arrow ), anterior intercavernous sinus (asterisk ), sphenoparietal sinus (yellow arrowheads), and paracavernous sinus (red arrows). Closed black arrow indicates GDC coils; long white arrow, right cavernous sinus.

D, Coronal view of 3D CT angiogram obtained with the volume rendering technique, using anterior cutting, clearly depicts intercavernous sinus (asterisk ). Arrow indicates right cavernous sinus.



View larger version (139K):

[in a new window]
  		FIG 2. Case 2: 69-year-old woman with dural cavernous fistula.

A, Frontal view of 3D CT angiogram obtained with the volume rendering technique shows an enlarged left SOV at the superior orbital fissure (single arrow ) and dilated angular veins (double arrows) bilaterally.

B, DSA (selective left external carotid injection, arterial phase, lateral view) shows rapid opacification of a portion of the cavernous sinus (single black arrow ) supplied by middle meningeal artery branches (double black arrows) and draining anteriorly into an enlarged left SOV (yellow arrow ).

C, 3D CT angiogram obtained with the volume rendering technique (superior view) shows bilateral enlarged cavernous sinuses (arrows).

D, CT angiogram (superior view) better depicts the prominent left cavernous sinus (arrows) after cutting to exclude supracavernous internal carotid artery.



View larger version (105K):

[in a new window]
  		FIG 3. Case 3: 54-year-old woman with dural CCF and right exophthalmos, chemosis, and dilated episcleral vessels.

A, CT angiogram (axial source image) shows an enlarged right cavernous sinus with irregular wall (yellow arrows) and large ipsilateral basilar plexus (asterisk ). White arrows indicate vertebral arteries.

B and C, Superolateral (B ) and posterior (C ) views of 3D CT angiogram obtained with the volume rendering technique show inferior petrosal sinuses along the posterior surface of the petrous bone (yellow arrows). Note the good delineation of skull and vascular anatomy. Asterisk indicates basilar plexus; white arrows, vertebral arteries.

D–F, Superolateral view of 3D CT angiogram obtained with the volume rendering technique (D ) shows enlarged cavernous sinus (yellow arrow ). Small vessels (blue arrows) might correspond to arteriovenous shunts, well depicted by lateral selective internal maxillary injection on DSA (E ). CT angiogram (axial source image) after superselective intraarterial embolization shows n-butyl cyanoacrylate in these arterial feeders (F ).



View larger version (187K):

[in a new window]
  		FIG 4. Case 4: 69-year-old woman with a dural fistula involving bilateral cavernous sinuses.

A, CT angiogram (axial source image) shows enhancement of bilateral cavernous sinuses (double arrows) and enlarged left SOV (arrowhead ).

B, DSA (right common carotid injection, late arterial phase, anteroposterior view) shows early opacification of bilateral enlarged cavernous sinuses (arrows).

C, CT angiogram (axial source image), after partial embolization, shows partial thrombosis of left SOV (arrow ), without enhancement of left cavernous sinus (arrowheads), and persistent right enlarged cavernous sinus (asterisk ).

D, DSA (right common carotid injection, arterial phase, anteroposterior view) confirms rapid opacification of right cavernous sinus (asterisk ) and intercavernous sinus (thin arrow ), without enhancement of left cavernous sinus (thick arrow ).



View larger version (70K):

[in a new window]
  		FIG 5. Schematic anatomic diagram of the venous vasculature of the skull base (superior view). 1, superior ophthalmic vein; 2, anterior intercavernous sinus; 3, inferior ophthalmic vein; 4, pterygoid plexus; 5, middle meningeal vein; 6, superior petrosal sinus; 7, inferior petrosal sinus; 8, basilar venous plexus; 9, transverse sinus; 10, posterior intercavernous sinus; 11, cavernous sinus; 12, sphenoparietal sinus





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X