By Goetz Benndorf MD, PhD (auth.)
Dural cavernous sinus fistulas (DCSFs) symbolize a benign vascular affliction, consisting in an arteriovenous shunt on the cavernous sinus. within the absence of spontaneous answer, the fistula could lead to eye redness, swelling, proptosis, chemosis, ophthalmoplegia and visible loss. even though sleek imaging concepts have stronger the diagnostic, sufferers with low-flow DCSFs are nonetheless misdiagnosed. those sufferers can get erroneously handled for infections and irritation for months or years and are prone to visible loss. Early and correct analysis is helping to prevent deleterious scientific process the illness. This quantity presents an entire advisor to scientific and radiological prognosis in addition to to healing administration of DCSF with emphasis on smooth minimum invasive remedies. It commences with an informative description of suitable anatomy. After sections at the category, etiology and pathogenesis of DCSF, the medical symptomatology of the disorder is defined intimately. The position of contemporary non-invasive imaging instruments is then addressed with using computed tomography, magnetic resonance imaging and ultrasound. Intra-arterial electronic subtraction angiography (DSA), even supposing invasive, is still the most reliable and is vital for scientific decision-making and procedure in endovascular remedy. accordingly, a all through attention is given to either, 2D-DSA and 3D rotational angiography, together with fresh technological developments corresponding to twin quantity (DV) imaging and angiographic computed tomography (ACT). After a quick part on arteriovenous hemodynamics, the healing administration of DCSFs is defined intimately. particularly, a number of transvenous concepts, required for winning endovascular occlusion of DCSF, are mentioned extensive. This well-illustrated quantity might be priceless to all who may well come across DCSF of their medical practice.
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Extra resources for Dural Cavernous Sinus Fistulas: Diagnostic and Endovascular Therapy
Knosp et al. (1987a) focused in his studies on fetal cavernous sinus and preferred the term cavernous venous plexus referring to the CS as a network of distinct, individual veins. There is otherwise no doubt that trabeculae have been found in some CS. Through the CS passes the ICA, surrounded by a plexus of sympathetic nerves. These structures are separated from the blood by a layer of endothelium. According to Lang (1979a), in an embryo there exists a venous plexus that is in 70% of the cases replaced by a single blood space, which can be traversed by 10–60 trabeculae.
1984). This concept ﬁnds, at least in part, support in the angiographic pattern of the CS in normal carotid artery venograms and in the angioarchitecture of many DCSFs or CCFs. The angiographic pattern of the CS varies signiﬁcantly in size and shape but is often one of a more or less single vascular space on each side of the sphenoid bone. In most direct highﬂow carotid cavernous ﬁstulas (CCFs), the blood seems to shunt into a single more or less enlarged cavity in which large detachable balloons may easily migrate after being detached.
The dura mater of the medial surface can be very thin or fenestrated. 1 2 4 3 The lower surface is covered by the periost of the ﬂoor of the middle cranial fossa. The roof of the CS is formed by the anterior extension of the tentorium and the lateral extension of the diaphragm sellae, while the lateral wall is formed by the dura propria of the middle cranial fossa. Various concepts and contradictory descriptions of the lateral wall of the CS exist (Umansky and Nathan 1987). While most classical textbooks (Warwick and Williams 1973; Christensen and Telford 1978) describe CNs III, IV and V1, V2 as being embedded in the lateral wall, others (Paturet 1964; Rouviere 1970) differentiate a deep and a superﬁcial layer of the lateral wall, dividing the CS into two compartments by a “septum” and 6 5 7 8 9 10 11 12 13 14 16 15 1 2 3 4 5 6 7 8 9 10 11 12 Fig.