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Spontaneous direct carotid-cavernous fistula in childhood
M D Gossman1, A J Berlin, M A Weinstein
1Department of Ophthalmology, Cleveland Clinic Foundation, Ohio.
Insights
A rare spontaneous carotid-cavernous fistula in a child, directly from the internal carotid artery, required surgical closure. This case highlights unique features and management of pediatric direct carotid-cavernous fistulas.
Area of Science:
- Vascular Surgery
- Pediatric Neurology
- Ophthalmology
Background:
- Spontaneous carotid-cavernous fistulas (CCFs) are rare in children.
- Direct CCFs arising from the internal carotid artery are exceptionally uncommon in this age group.
Observation:
- A child presented with a spontaneous, direct left-sided carotid-cavernous fistula.
- Contralateral proptosis was a notable clinical feature.
- Angiography confirmed the direct communication between the internal carotid artery and the cavernous sinus.
Findings:
- This is the third documented spontaneous CCF in a child and the first direct internal carotid artery origin reported in the literature.
- Unlike other reported nonprogressive cases, this fistula necessitated surgical closure.
- The patient underwent successful fistula closure with long-term follow-up.
Implications:
- This case expands the understanding of rare pediatric vascular anomalies.
- It underscores the importance of considering direct CCFs in pediatric proptosis evaluations.
- Management strategies for pediatric direct CCFs may require individualized surgical intervention.
Abstract:
We report the occurrence, surgical treatment and long-term follow-up of a spontaneous, direct carotid-cavernous fistula in a child. It is the third angiographically documented, spontaneously occurring fistula to be reported in this age group and the first to arise directly from the internal carotid artery based on our review of the literature. Although our patient required fistula closure, other reported fistulae were nonprogressive and did not require treatment. The communication between the internal carotid artery and the cavernous sinus was left sided while the contralateral eye was proptotic. The clinical features, selected hemodynamic characteristics, and treatment of carotid-cavernous fistulas are reviewed.