Treatment of Carotid-Cavernous Fistula by Gelfoam Embolization

Ishimori, Shoji; Hattori, Mitsuo; Shibata, Yoshiyuki; Shizawa, Hisao; Fujinaga, Ryozo

doi:10.3171/jns.1967.27.4.0315

Cited by 63 publications

(11 citation statements)

References 10 publications

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“…& Trapping of the fistula by ligation of the cervical and intracranial ICA is still considered an effective treatment for direct CCFs. & Carotid sacrifice has also been performed via embolization using different materials delivered by direct carotid exposure [46,47]. However, sacrifice of the ICA is performed sparingly because of a significant risk of cerebral infarction even after a successful balloon test occlusion.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Treatment of Carotid Cavernous Fistulas

Gemmete

Chaudhary

Pandey

et al. 2010

Curr Treat Options Neurol

110

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The treatment of a carotid cavernous fistula (CCF) depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. In most instances, endovascular treatment is preferred.High-flow direct CCFs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. They usually present with sudden development of a clinical triad: exophthalmos, bruit, and conjunctival chemosis. All direct CCFs should receive treatment, because they carry a high probability of intracranial hemorrhage or neurologic deterioration.Low-flow indirect or dural CCFs, either incidental or with minimal symptoms, are not associated with significant risk of intracranial hemorrhage. The accepted practice is to treat ocular symptoms conservatively with medical management or manual carotid compression. If the patient cannot tolerate the symptoms, or if signs of ocular morbidity occur, endovascular treatment is offered.The first treatment option should be endovascular embolization with a combination of detachable balloons, coils, stents, or liquid embolic agents. The procedure can be performed from either an arterial or venous approach. Use of these materials and techniques can yield a high cure rate with minimal complications.If the patient is not amenable to embolization or if the embolization fails, then surgery (surgical ligation of the internal carotid artery or packing of the cavernous sinus) should be offered.Stereotactic radiosurgery may be an elective treatment for low-flow CCFs, but it has no role in the treatment of high-flow CCFs.

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Section: Surgical Treatmentmentioning

confidence: 99%

Treatment of Carotid Cavernous Fistulas

Gemmete

Chaudhary

Pandey

et al. 2010

Curr Treat Options Neurol

110

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“…[4,30,39,53] Early reports on the treatment of these lesions began with unselective catheterization of the ECA and embolization with particles or coils. This technique has been abandoned because of a high recurrence rate.…”

Section: Transarterial Approachmentioning

confidence: 99%

Current concepts on carotid artery-cavernous sinus fistulas

Benitez¹,

Armonda²,

Harrop³

et al. 1998

FOC

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With greater understanding of the pathophysiological mechanisms by which carotid artery-cavernous sinus fistulas occur, and with improved endovascular devices, more appropriate and definitive treatments are being performed. The authors define cartoid cavernous fistulas based on an accepted classification system and the signs and symptoms related to these fistulas are described. Angiographic evaluation of the risk the lesion may pose for precipitating stroke or visual loss in the patient is discussed. The literature on treatment alternatives for the different types of fistulas including transvenous, transarterial, and conservative management is reviewed.

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“…Most subsequent authors of that time all quote ‘Brooks' method of muscle embolization.’ Sedzimir and Occleshaw15 ‘operation of muscle embolization — Brooks' method.’ Ishimori et al 16 state that ‘Brooks was considered to be the first to have carried out occlusion of the carotid-cavernous fistula with thrombus-making material.’ Kosary et al 17 quote ‘successful treatment of a case by muscle embolization alone by Brooks.’ Arutinnov et al 18: ‘Original Brooks operation has one important drawback: the muscular embolus is not controlled.’ Riechert,19 ‘Introduction of a small embolus of muscle after Brooks.’ Wanissorn20 quotes ‘The intraluminal embolization method of Brooks.’…”

Section: Pre-balloon Eramentioning

confidence: 99%