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Direct carotid cavernous fistula in infancy: presentation and treatment
Ansaar T Rai1, Jennifer A Sivak-Callcott, Chris Larzo
1Department of Neuroradiology, West Virginia University, Morgantown, WV 26506-9235, USA.
Insights
A rare carotid-cavernous fistula in an infant was successfully treated with coil embolization. This intervention resolved orbital venous congestion and normalized intraocular pressure, marking a significant advancement in pediatric neurovascular care.
Area of Science:
- Neuroscience
- Vascular Surgery
- Pediatric Ophthalmology
Background:
- Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.
- While CCFs are well-documented in adults, their occurrence in infancy is exceptionally rare.
Observation:
- An 11-month-old infant presented with symptoms indicative of orbital venous congestion.
- Imaging revealed an enlarged superior ophthalmic vein and cavernous sinus on the affected side.
- Catheter angiography confirmed a direct carotid-cavernous fistula with extensive venous drainage.
Findings:
- The direct carotid-cavernous fistula in this infant was successfully treated using endovascular coil embolization.
- Post-embolization, the infant's symptoms of orbital venous congestion completely resolved.
- Intraocular pressures, initially elevated, returned to normal levels following the procedure.
Implications:
- This case represents the first reported instance of a carotid-cavernous fistula in infancy.
- Successful endovascular treatment in this infant suggests feasibility and efficacy of this approach for pediatric CCFs.
- Highlights the importance of considering rare vascular anomalies in infants presenting with ophthalmologic symptoms.
Abstract:
An 11-month-old female patient presented with symptoms of orbital venous congestion. A CT scan showed enlarged superior ophthalmic vein and cavernous sinus on the symptomatic side. Catheter angiography confirmed a direct carotid-cavernous fistula with intra- and extracranial venous drainage. Successful coil embolization of the fistula was performed with resolution of the infant's symptoms and return of previously elevated intraocular pressures to normal. To our knowledge, no cases of carotid cavernous fistulas in infancy have been previously reported.