Summary
A young woman presented with a spontaneous carotid-cavernous fistula. She also had fibromuscular dysplasia of the extracranial cerebral arteries. The possible relationship of the two diseases brought up important questions concerning how to manage the patient. Treatment by obliteration of the carotid circulation on one side would be expected to increase blood flow on the other side. If the cavernous carotid artery on the second side was weakened by fibromuscular dysplasia, the increased flow might predispose to the formation of a second carotidcavernous fistula. We first attempted to avoid surgery. When progressive symptoms occurred, the cavernous sinus was obliterated with bronze wire, thus preventing venous shunting.
Similar content being viewed by others
References
Anderson, P. E., Fibromuscular hyperplasia of the carotid arteries. Acta Radiol. (Diag.)10 (1970), 90–96.
Bahuliyan, K., Nelson, L. R., Peck, F. C., Occlusion of carotid-cavernous fistula with a balloon catheter. Surg. Neurol.3 (1975), 283–287.
Black, P., Uematsu, S., Perovic, M.,et al., Carotid-cavernous fistula: a controlled embolus technique for occlusion of fistula with preservation of carotid blood flow. J. Neurosurg.38 (1973), 113–118.
Dohn, D. F., Carotid aneurysms and arterio-venous fistulae of the cavernous sinus. In: Neurological Surgery (Youmans, J. R., Jr., ed.), pp. 807–826. Philadelphia: Saunders. 1973.
Elias, W. S., Intracranial fibromuscular hyperplasia. JAMA218 (1971), 254.
Hamby, W. B., Carotid-cavernous Fistula, Springfield, Ill.: Ch. C Thomas. 1966.
Hosobuchi, V., Electrothrombosis of carotid-cavernous fistula. J. Neurosurg.42 (1975), 76–85.
Houser, O. W., Baker, H. L., Sandok, B. A., Holley, K. E., Fibromuscular dysplasia of the cephalic arterial system. In: Handbook of Clinical Neurology, Vol. 11 (Vinken, P. J., Bruyn, G. S., eds.), pp. 366–385. New York: Elsevier. 1972.
Huber, V. P., Fuchs, W. A., Gibt es eine fibromuskuläre Hyperplasie zerebraler Arterien? Fortschr. Roentgenstr.107 (1967), 119–126.
Iosue, A., Kier, E. L., Ostrow, D., Fibromuscular dysplasia involving the intracranial vessels. J. Neurosurg.37 (1972), 749–752.
Jaeger, R., Martin, J. D., Jr., Mabon, R. F., Discussion. JAMA121 (1943), 335.
Kaufman, H. H., Fibromuscular hyperplasia of the carotid artery in a case associated with an arteriovenous malformation. Arch. Neurol.22 (1970), 299–304.
Manelfe, C., Clarisse, J., Fredy, D.,et al., Dysplasies fibromusculaires des artères cervico-céphaliques. J. Neuroradiol.1 (1974), 149–231.
Markham, J. W., Carotid-cavernous sinus fistula treated by intravascular occlusion with a balloon catheter. J. Neurosurg.40 (1974), 535–538.
Mullan, S., Experiences with surgical thrombosis of intracranial berry aneurysms and carotid-cavernous fistulas. J. Neurosurg.41 (1974), 657–670.
Obrador, S., Gomez-Bueno, J., Silvela, J., Spontaneous carotid-cavernous fistula produced by ruptured aneurysm of the meningo-hypophyseal branch of the internal carotid artery. J. Neurosurg.40 (1974), 539–543.
Ohta, T., Nishimura, S., Kikuchi, H., Toyama, M., Closure of carotid-cavernous fistula with polyurethane foam embolus. J. Neurosurg.38 (1973), 107–112.
Parkinson, D., A surgical approach to the cavernous portion of the carotid artery. J. Neurosurg.23 (1965), 474–483.
Parkinson, D., Carotid-cavernous fistula: direct repair with preservation of the carotid artery. J. Neurosurg.38 (1973), 99–106.
Peterson, E. W., Valberg, J., Wittingham, D. S., Electrically induced thrombosis of the cavernous sinus in the treatment of carotid-cavernous fistula. Excerpta Med. Int. Cong. Series193 (1969), 105.
Pilz, P., Hartjes, H. J., Fibromuscular dysplasia and multiple dissecting aneurysms of intracranial arteries. Stroke7 (1976), 393–398.
Prolo, D. J., Hanbery, J. W., Intraluminal occlusion of a carotid-cavernous fistula with a balloon catheter. J. Neurosurg.35 (1971), 237–242.
Sahs, A. L., Perret, G. E., Locksley, H. B., Nishioka, H. (eds.), Intracranial Aneurysms and Subarachnoid Hemorrhage. Philadelphia: Lippincott. 1969.
Schoolman, A., Kepes, J. J., Bilateral spontaneous carotid-cavernous fistulae in Ehlers-Danlos Syndrome. J. Neurosurg.26 (1967), 82–86.
Stanley, J. G., Frey, W. J., Seeger, J. F.,et al., Extracranial internal carotid and vertebral artery fibrodysplasia. Arch. Surg.109 (1974), 215–222.
Stebbens, W. E., Pathology of cerebral blood vessels, pp. 623–625. St. Louis: Mosby. 1972.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kaufman, H.H., Lind, T.A. & Mullan, S. Spontaneous carotid-cavernous fistula with fibromuscular dysplasia. Acta neurochir 40, 123–129 (1978). https://doi.org/10.1007/BF01773120
Issue Date:
DOI: https://doi.org/10.1007/BF01773120