title: [Arterio-venous fistula of cavernous sinus. A comparison of iatrogenic direct fistula with low flow dura shunt syndrome].
abstract: OBJECTIVE
  Comparison of symptoms of the low-flow dura shunt syndrome as a small arterial anomaly in the cavernous sinus with the direct, traumatic originated internal carotid artery fistula.
  
  
  METHODS
  The clinical case report for two patients. The first case with a direct cavernous sinus fistula was diagnosed using angiography and the patient was treated with a detachable balloon catheter through the inferior petrousal sinus. The second case after the diagnosis was followed up with doppler sonography.
  
  
  RESULTS
  The first case developed the direct cavernous sinus fistula after second thrombarteriotomy of the right internal carotid stenosis. The diagnosis, by typical clinical symptoms, was confirmed through the cavernous sinus angiogram with enlarged superior and inferior ophthalmic veins. The drainage was accomplished through the inferior petrousal sinus and the intercavernous sinus with accompanying signs of cortical drainage. All clinical symptoms, except for the abducens nerve palsy and the incomplete oculomotor nerve palsy, were reduced after neurosurgical occlusion of the fistula. The second case with the low-flow dura shunt syndrome was symptomatic by hypertension crisis and some spontaneous reduction was noticed.
  
  
  CONCLUSIONS
  The iatrogenic direct cavernous sinus fistula is seldom but a very dangerous vital complication of the internal carotid arterial stenosis surgery and must be immediately closed through the endovascular embolisation therapy. The low-flow dura shunt syndrome may be in 50% occluded spontaneously.
authors.affiliation: Z Kliniki Okulistycznej w Centrum Medycznym im R. Virchowa w Salzgitter.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Holak
authors.forename: Nikolai
authors.initials: N
authors.lastname: Holak
authors.forename: Bertram
authors.initials: B
authors.lastname: Schier
authors.forename: Sophie
authors.initials: S
authors.lastname: Holak
authors.forename: Janusz
authors.initials: J
authors.lastname: Huzarski
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000473:pathology*; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000209:etiology; D002404:Catheterization; D002426:Cavernous Sinus; D002533:Cerebral Angiography; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy / Q000009:adverse effects*; D018608:Ultrasonography, Doppler