Endovascular treatment of carotid cavernous sinus fistula: A systematic review

Abstract

Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.

Endovascular Treatment of Carotid Cavernous Fistulae: A Study of Management and Outcome

“…In type D fistulas, the ECA system is usually embolized first, since it may be sufficient to decrease symptoms. In bilateral fistulas, embolisation of the most symptomatic side may also occlude the contralateral fistula [14] .…”

New daily persistent headache — rare primary or secondary phenomena caused by carotid-cavernous fistula? A case report

“…This type of headache is one of the most common and often difficult headache disorders for diagnosis and therapy. Guidelines suggest making diagnosis of NDPH after the exclusion of many possible causes of secondary headaches by history, radiological examination and testing [13,14]. Typical findings of noninvasive cerebral imaging with CT scanning and/or MRI can be suggestive of CCF [13].…”

“…While low risk CCF with mild symptomatology can be managed conservatively, higher risk fistulas deserve the most aggressive approach in order to eradicate the fistula. It includes surgical managements, radiosurgery and endovascular interventions such as detachable balloon occlusion, coil and material embolization (performed in our patients), covered stent graft placement, parent artery occlusion and transvenous or transarterial embolization [14].…”

The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: our first experience

“…However sacrifice of the ICA is performed carefully due to significant risk of cerebral infarction even after successful balloon test occlusion studies [2,3,5].…”