Classification and treatment of spontaneous carotid-cavernous sinus fistulas

Abstract

An anatomical-angiographic classification for carotid-cavernous sinus fistulas is introduced and a series of 14 patients with spontaneous carotid-cavernous sinus fistulas is reviewed to illustrate the usefulness of such a classification for patient evaluation and treatment. Fistulas are divided into four types: Type A are direct high-flow shunts between the internal carotid artery and the cavernous sinus; Type B are dural shunts between meningeal branches of the internal carotid artery and the cavernous sinus; Type C are dural shunts between meningeal branches of the external carotid artery and the cavernous sinus; and Type D are dural shunts between meningeal branches of both the internal and external carotid arteries and the cavernous sinus. The anatomy, clinical manifestations, angiographic evaluation, indications for therapy, and therapeutic options for spontaneous carotid-cavernous sinus fistulas are discussed.

Traumatic Middle Meningeal Artery and Fistula Formation with the Cavernous Sinus and a Review of the Literature on Endovascular Management of Traumatic Carotid Cavernous Fistulas

“…Many cases of middle meningeal fistula in association with head trauma were reported. [1][2][3][4][5][6][7][8][9][10][11][12] However, we are not aware of a reported case treated by detachable balloon and without skull fracture. In the present case, one month passed between head injury and the appearance of intracranial bruits.…”

“…A delayed onset of symptoms is mainly attributable to disruption of dural venous drainage and increased intracavernous pressure. [1][2][3]5,8] Neurosurgeons should be aware of this possibility that DAVF in the middle meningeal artery in patients without skull fracture. In our case, initially the common carotid angiography was performed [ Fig.2] and the lesion was misdiagnosed as Barrow Type A.…”

“…Endovascular embolization is the treatment choice of the DAVF of the middle meningeal artery, and has some advantages over surgical treatment. [1,[3][4][5]9] Embolic materials should be selected carefully depending on the type and size of the lesions to prevent complications and recanalization. [1,[3][4][5]9] In our cases, we used detachable balloon to treat the DAVF, which resulted in successful embolization.…”

“…[1][2][3][4][5][6][7][8] This vascular lesion might be missed unless it exhibits clinical manifestations or are incidentally discovered during radiological examination such as magnetic resonance imaging or conventional angiography. [1][2][3][4][5][6][7][8] Here we present a case of traumatic middle meningeal artery, which subsequently established a fistula with the cavernous sinus. We also discuss the methods used for treatment of traumatic carotid cavernous fistulas [TCCFs].…”

Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

“…1 Barrow et al defi ne four types (A -D) of CCF, depending on the blood supply. 2 Type A is the most common (75-80%) and is a direct, high-velocity shunt from the ICA to the CS, caused by a lesion of the wall of the artery due to trauma or aneurysmal rupture. 1,2 CCF types B, C and D result from an indirect communication between CS and the meningeal branches of ICA (type B), ECA (type C) or both ICA and ECA (type D).…”