title: Spontaneous Bilateral Carotid-Cavernous Fistulas Secondary to Cavernous Sinus Thrombosis.
abstract: Bilateral carotid cavernous fistulas are rare entities that can cause debilitating symptoms and can lead to more severe consequences if left untreated. Therefore, the recognition and adequate treatment of these pathologies is very important. We present 2 cases of bilateral carotid cavernous fistulas that arose as a result of cavernous sinus thrombosis. We review the literature and discuss the pathophysiology, symptomatology, management, and treatment of bilateral carotid cavernous fistulas. Within our own cases, treatment of the patients was varied. The patient in case 1 was successfully treated with endovascular therapy after a failed trial of anticoagulation. The patient in case 2 demonstrated resolution of bilateral carotid cavernous fistulas after anticoagulation therapy. Case 2 highlights the fact that certain cases of bilateral carotid cavernous fistulas due to cavernous sinus thrombosis may benefit from extensive anticoagulation therapy. If anticoagulation therapy is unsuccessful, endovascular therapy may prove beneficial in resolving the fistulous shunt.
authors.affiliation: Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Krishna
authors.initials: K
authors.lastname: Amuluru
authors.affiliation: Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Mohammad
authors.initials: M
authors.lastname: El-Ghanem
authors.affiliation: Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Abhinav R
authors.initials: AR
authors.lastname: Changa
authors.affiliation: Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Inder Paul
authors.initials: IP
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Chirag D
authors.initials: CD
authors.lastname: Gandhi
authors.affiliation: Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Prestigiacomo
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000069461:Bendamustine Hydrochloride; D020216:Carotid-Cavernous Sinus Fistula / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D020226:Cavernous Sinus Thrombosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000925:Anticoagulants; D000069461:Bendamustine Hydrochloride
keywords: Anticoagulation; Carotid-cavernous fistulas; Cavernous sinus thrombosis; Dural fistula; Endovascular therapy; Neuroradiology; Otitis media