Related Experiment Video
Updated: Jun 23, 2026
14:58
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Direct carotid-cavernous fistula causing brainstem venous congestion
Miguel Bussière1, Stephen P Lownie, David M Pelz
1Division of Neuroradiology, Department of Diagnostic Radiology and Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada. miguel.bussiere@toh.on.ca
Summary
A direct carotid-cavernous fistula (CCF) caused severe brainstem issues in a patient. Prompt treatment by closing the fistula reversed these serious neurological complications.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Direct carotid-cavernous fistulas (CCFs) are rare vascular abnormalities.
- CCFs can lead to significant neurological deficits due to abnormal blood flow.
- Posterior fossa venous drainage from CCFs is an uncommon but serious presentation.
Observation:
- A 39-year-old man presented with unilateral proptosis and periocular pain.
- Rapid neurological deterioration occurred, including reduced consciousness, facial numbness, dysarthria, and gait ataxia.
- Brain MRI showed abnormal signals in the brainstem, suggesting venous hypertension and edema.
Findings:
- The patient's symptoms were attributed to a direct CCF with unusual posterior fossa venous drainage.
- Successful closure of the fistula using a detachable balloon was achieved.
- Post-treatment imaging and clinical evaluation revealed complete resolution of brainstem abnormalities.
Implications:
- This case underscores the potential for severe, reversible brainstem complications from direct CCFs.
- Early diagnosis and endovascular intervention are crucial for managing such cases.
- Highlights the importance of considering CCF in patients with unexplained neurological deficits and orbital signs.
Related Concept Videos
01:26Arteries of the Head and Neck
The human body's intricate network of arteries ensures that every organ system receives the necessary oxygen and nutrients for optimal function. The arterial network in the head and neck region is particularly complex, providing vital blood flow to the brain, eyes, and other critical structures. Prominent arteries in this region include the internal carotid arteries and the vertebral arteries.
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:10The Arch of Aorta
The coronary arteries, originating from the ascending aorta, bifurcate from two sinuses located within the ascending aorta. Positioned just above the aortic semilunar valve, these sinuses house essential aortic baroreceptors and chemoreceptors, crucial for maintaining cardiac function. The left coronary artery and the right coronary artery branch off from the left posterior and anterior aortic sinuses, respectively.
Encircling the heart, the coronary arteries form a ring-like structure before...
Encircling the heart, the coronary arteries form a ring-like structure before...
01:19Veins of Head and Neck
The blood drainage from the head and neck is primarily managed by three pairs of veins: the external jugular, internal jugular, and vertebral veins. The external jugular veins drain superficial scalp and face structures, passing over the sternocleidomastoid muscles to empty into the subclavian veins.
On the other hand, the vertebral veins, unlike their arterial counterparts, are not primarily responsible for brain drainage. Instead, they drain the cervical vertebrae, spinal cord, and some small...
On the other hand, the vertebral veins, unlike their arterial counterparts, are not primarily responsible for brain drainage. Instead, they drain the cervical vertebrae, spinal cord, and some small...
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
01:29Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...