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Dural arteriovenous shunts in the region of the cavernous sinus

Shunts artérioveineux duraux dans la région du sinus caverneux

Durale arteriovenöse Kurzschlüsse in der Region des Sinus cavernosus

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Summary

Dural arteriovenous shunts in the region of the cavernous sinus probably account for most so-called spontaneous carotid-cavernous sinus fistulae. Eleven patients with this type of dural shunt were found in a review of 30 carotid cavernous-sinus fistulae. These shunts usually appear in middle-aged women as a distinctive syndrome. The signs usually are mild and include dilated conjunctival veins, proptosis, and bruit. Transient sixth-nerve palsy and unilateral headache frequently antedate orbital signs by many months. Spontaneous resolution is common.—Complete and selective cerebral angiography is essential for diagnosis. The dural shunt is usually one of low flow and low pressure, allowing normal opacification of intracranial arteries during carotid arteriography. Arterial contributions to these fistulae arise from meningcal branches of the internal and external carotid arteries. Terminal meningeal branches of the internal maxillary artery are the most common source of blood from the external carotid artery that supply the fistula. The most frequent source from the internal carotid artery is the meningo-hypophyseal trunk. Contributions from the contralateral dural vessels were frequently observed. The fistula is usually situated posteriorly in the cavernous sinus and, in most instances, venous drainage extends anteriorly into the ophthalmic veins.

Résumé

Description de onze cas de shunt artérioveineux du sinus caverneux. L'alimentation artérielle provient de branches méningées des artères carotides internes et externes. Dans le domaine de la carotide externe l'alimentation se fait surtout par les branches méningées de l'artère maxillaire interne tandis que la carotide interne intervient surtout par le tronc méningohypophysaire; le drainage veineux se fait habituellement par les veines orbitaires.

Zusammenfassung

Arteriovenöse Verbindungen von Duragefäßen in der Region des Sinus cavernosus sind oftmals verantwortlich für die spontanen Fisteln zwischen der A. carotis und dem Sinus cavernosus. In dem Krankengut der Verfasser fanden sich 30 Sinus cavernosus-Fisteln, von denen 11 diesen Typ eines duralen Shunts erkennen ließen. Die neurologische Symptomatik wird beschrieben. Für die neuroradiologische Diagnostik ist eine komplette und eins selektive Carotisarteriographie erforderlich. Der arterielle Blutzufluß zu diesen Fisteln kommt von meningealen Ästen der A. carotis interna und externa. Für den Blutzufluß von der A. carotis externa sind die Endabschnitte meningealer Äste der A. maxillaris von besonderer Bedeutung. Bei der A. carotis interna handelt es sich um den meningo-hypophysealen Gefäßstamm.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Radiology, University of California, San Francisco Medical Center, San Francisco, California, USA

    T. H. Newton & W. F. Hoyt

  2. Division of Neurological Surgery, University of California, San Francisco Medical Center, San Francisco, California, USA

    T. H. Newton & W. F. Hoyt

  3. Department of Ophthalmology, Universith of California, San Francisco Medical Center, San Francisco, California, USA

    T. H. Newton & W. F. Hoyt

  4. Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California, USA

    T. H. Newton & W. F. Hoyt

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  1. T. H. Newton
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  2. W. F. Hoyt
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Newton, T.H., Hoyt, W.F. Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1, 71–81 (1970). https://doi.org/10.1007/BF00389438

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