Mujer de 51 años con antecedentes de lesión cerebral traumática y diagnóstico de fístula cavernosa carotídea directa (de alto flujo). Presentó transtornos oculares en ambos ojos, con quemosis significativa (Fig. 1A), consecuencia de la congestión venosa asociada. La angiografía cerebral confirmó el diagnóstico y mostró comunicación entre la carótida y los senos cavernosos por los senos intercavernosos (Fig. 1 B y C). Fue tratada con un globo desprendible en el seno cavernoso derecho, se cerró la fístula (Fig. 2 A y B), y mejoraron los cambios oculares (Fig. 2 C).
La fístula cavernosa carotídea directa puede causar proptosis, transtornos de la visión, quemosis en ambos ojos,
el tratamiento endovascular es el estándar. Este se puede hacer por vía transvenosa o transarterial, con la posibilidad de utilizar diferentes dispositivos. En el presente caso, se utilizó un balón desmontable.
João Miguel de Almeida Silva, Guilherme B. de Aguiar, José Carlos E. Veiga, Maurício Jory, Mario L.M. Conti
Departamento de Cirugía, Servicio de Neurocirugía, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
e-mail: guilhermebraguiar@yahoo.com.br
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