Orbital Approaches for Treatment of Carotid Cavernous Fistulas: A Systematic Review

Phan, Kevin; Xu, Joshua; Leung, Vannessa; Teng, Ian; Sheik-Ali, Sharaf; Maharaj, Monish; Mobbs, Ralph J.; Rao, Prashanth J.

doi:10.1016/j.wneu.2016.08.087

Cited by 37 publications

(49 citation statements)

References 33 publications

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“…Currently, various EVTs are available for CS-DAVFs, mainly including transfemoral transvenous embolization (TVE) and transarterial embolization (TAE), a transorbital puncture approach, and direct puncture or surgical exposure to obtain transvenous access to the CS [3,5,43].…”

Section: Outline Of Evtmentioning

confidence: 99%

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Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Hou¹,

Li²,

Luan³

et al. 2020

Int. J. Med. Sci.

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A cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal arteriovenous communication involving the dura mater within or near the CS wall. The dural arteries from the internal carotid artery and external carotid artery supply the CS-DAVF, and the superior ophthalmic vein (SOV) and inferior petrous sinus (IPS) are frequent venous drainers. In CS-DAVF cases, high-risk lesions require treatment. Endovascular treatment (EVT) has been the first-line option for CS-DAVFs. To our knowledge, a review of the EVT of CS-DAVFs is lacking. Therefore, in this paper, we review the available literature on this issue. In addition, some illustrative cases are also provided to more concisely expound the EVT of CS-DAVFs. According to the recent literature, transvenous embolization via the IPS is considered the most effective method for EVT of CS-DAVFs. In addition, the transorbital approach is another reasonable choice. Other venous approaches can also be tried. Because of the low cure rate, transarterial embolization for CS-DAVFs is limited to only highly selected patients. In the EVT of CS-DAVFs, various agents have been used, including coil, Onyx, and n-butyl cyanoacrylate, with coil being the preferred one. In addition, when EVT cannot obliterate the CS-DAVF, stereotactic radiotherapy may be considered. In general, despite various complications, EVT is a feasible and effective method to manage CS-DAVFs by way of various access routes and can yield a good prognosis.

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Section: Outline Of Evtmentioning

confidence: 99%

“…Currently, endovascular treatment (EVT) has become the first-line choice for CS-DAVFs [4]. In addition, adjuvant radiosurgery may be considered after unsatisfactory EVT [5].…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Hou¹,

Li²,

Luan³

et al. 2020

Int. J. Med. Sci.

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“…58 A recent systematic review reported a 90% success rate with no major complications among CCF embolization procedures completed via an orbital approach. 63 Coils commonly are used in transvenous procedures (Figure 10). Nylon-fibred platinum coils are preferred to bare platinum coils due to their improved thrombogenicity.…”

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confidence: 99%

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Henderson

Miller

2017

Eye

197

232

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A carotid-cavernous fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as either direct or dural. Direct CCFs are characterized by a direct connection between the internal carotid artery (ICA) and the cavernous sinus, whereas dural CCFs result from an indirect connection involving cavernous arterial branches and the cavernous sinus. Direct CCFs frequently are traumatic in origin and also may be caused by rupture of an ICA aneurysm within the cavernous sinus, Ehlers-Danlos syndrome type IV, or iatrogenic intervention. Causes of dural CCFs include hypertension, fibromuscular dysplasia, Ehlers-Danlos type IV, and dissection of the ICA. Evaluation of a suspected CCF often involves non-invasive imaging techniques, including standard tonometry, pneumotonometry, ultrasound, computed tomographic scanning and angiography, and/or magnetic resonance imaging and angiography, but the gold standard for classification and diagnosis remains digital subtraction angiography. When a direct CCF is confirmed, first-line treatment is endovascular intervention, which may be accomplished using detachable balloons, coils, liquid embolic agents, or a combination of these tools. As dural CCFs often resolve spontaneously, low-risk cases may be managed conservatively. When invasive treatment is warranted, endovascular intervention or stereotactic radiosurgery may be performed. Modern endovascular techniques offer the ability to successfully treat CCFs with a low morbidity and virtually no mortality.

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“…7 Los abordajes orbitarios se consideran arriesgados en comparación con el abordaje tradicional a través del seno petroso inferior, por lo que se utilizan de segunda opción. 8 La disfunción del tronco encefálico con congestión venosa o hemorragia es una complicación poco frecuente de FCC. 9 En la mayoría de las ocasiones, es causada por la congestión venosa.…”

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“…9,10 El pronóstico ha mejorado de forma considerable en los últimos 20 años gracias a los avances en la neurorradiología intervencionista. 8 2 Caso Clinico Paciente de género masculino de 53 años de edad, mestizo, y casado. Con antecedentes de hipertensión diagnosticada hace 5 años, tratado con Losartan 50 mg/día, tabaquismo crónico hace aproximadamente 35 años.…”

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Caso clínico: Fístula Carótido Cavernosa

Arcos

Toral-Sanchez

Peña-Aguilera

2019

Salud

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\textbf{Objetivo}: Describir caso clínico sobre fístula carótida cavernosa para dar a conocer la importancia del diagnóstico precoz de la misma, así como del control de la presión intraocular. \textbf{Materiales y Métodos}: Reporte de un caso clínico de un paciente en el periodo de julio de 2017 apoyado en recopilación bibliográfica actualizada sobre el tema previamente descrito. \textbf{Resultados}: La fístula carótido cavernosa es una entidad poco frecuente en la patología neuroquirurgica, con gran repercusión Neuro – Oftalmológica, por lo cual es de importancia establecer cuál la clasificación, prevención, manejo óptimo y en qué pacientes está indicado realizar una intervención quirúrgica o no. \cite{1} La fístula carótido-cavernosa es una conexión anómala entre la arteria carótida y el seno cavernoso, puede ser espontánea en 25\% de los casos o adquirida en el 75\% restante, principalmente de origen traumático, en otros de los casos por mal formaciones arterio-venosas. \cite{2} En cuanto a la evolución de las fístulas carótido- cavernosas indirectas es variable, aproximadamente poseen una resolución espontánea, debido a la retrombosis del segmento afectado del seno cavernoso. Sin embargo, si ocurre pérdida progresiva de la visión y glaucoma intratable se requiere el manejo quirúrgico inmediato. \textbf{Conclusiones}: La fístula carótido-cavernosa es un reto en cuanto al diagnóstico, tratamiento, y complicaciones, ya que forman parte de las afecciones neuro-oftalmicas poco frecuentes, pues asi se puede obtener un pronóstico positivo y mantener la calidad de vida del paciente; el diagnóstico precoz es un punto clave.

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Orbital Approaches for Treatment of Carotid Cavernous Fistulas: A Systematic Review

Cited by 37 publications

References 33 publications

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Caso clínico: Fístula Carótido Cavernosa

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