Author/Editor		Cvenkel, Barbara; Dolenc, Vinko V; Miloševič, Zoran
Title		Duralne karotiko-kavernozne fistule
Translated title		Dural carotid-cavernous fistulas
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 71, št. Suppl 2
Publication year		2002
Volume		str. II-31-3
Language		slo
Abstract		Background. Dural carotid-cavernous sinus fistulas (CCF) communications fed by meningeal branches of the intracavernous internal carotid artery (ACI) or/and external carotid artery (ACE). In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause. Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical oresentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present ("red-eyed shunt syndrome"). Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion ("white-eyed shunt syndrome"). Also different therapeutic approaches as well as possible complications are described. Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.
Summary		Izhodišča. Duralne karotiko-kavernozne fistule (KKF) so komunikacije med meningealnimi vejami intrakaveroznega dela arterije karotis interne (AKI) ali/in arterije karotis eksterne (AKE). Imajo manjši pretok in nižji tlak kot tipične KKF. Spontane duralne KKF so pogostejše pri ženskah po menopavzi. Etiologija ni znana, vzrok za nastanek so verjetno prirojene malformacije ali rupture duralnih arterij s tankimi žilnimi stenami znotraj venskih sinusov. Prikaz primerov. Opisana je klinična slika treh bolnikov, ki so bili zaradi neznačilne klinične slike zdravljeni kot kronični konjunktivitis, miozitis ekstraokularne mišice in psevdotumor orbite. Klinična slika je odvisna od smeri in velikosti fistularnega pretoka ter od anatomije kolateralnega obtoka. Če je povečan krvni pretok usmerjen v oftalmično veno, se pojavijo znaki orbito-okularne kongesije t.i. "red-eyed shunt syndrome". Drenaža duralne KKF v spodnji petrozni sinus lahko povzroči boleče pareze 3. in 6. možganskega živca brez znakov orbito-okularne kongesije ("white-eyed shunt syndrome"). Prikazane so možnosti zdravljenja in njihovi zapleti. Zaključki. Za postavitev dokončne diagnoze je potrebna angiografija, ki je dostikrat terapevtska, saj povzroči okluzijo KKF v 1/3 do 1/2 primerov. Zaradi možnih resnih očesnih in sistemskih zapletov je nevrokirurški poseg indiciran le v primerih medikamentno neurejenega sekundarnega glavkoma in hipoksične retinopatije.
Descriptors		CAROTID ARTERY, INTERNAL CAVERNOUS SINUS ARTERIOVENOUS FISTULA DURA MATER MIDDLE AGE ARTERIOVENOUS MALFORMATIONS