Dural carotid cavernous fistulas: role of conventional radiation therapy--long-term results with irradiation, embolization, or both.

Hirai, Toshinori; Korogi, Yukunori; Baba, Yuji; Nishimura, Ryuichi; Hamatake, Satoshi; Kawanaka, Koichi; Bussaka, H.; Takahashi, Manabu

doi:10.1148/radiology.207.2.9577491

Cited by 22 publications

(7 citation statements)

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“…Other small series of patients with indirect CCFs have shown long-term obliteration of the fistula after treatment with radiosurgery in 75%-100% of patients. 3,17,28,53,64 Radiosurgery should not be used in emergency cases, as there is a latency of several months to years before complete obliteration of the CCF is accomplished. …”

Section: Radiosurgical Interventionmentioning

confidence: 99%

Carotid-cavernous fistulas

Ellis¹,

Goldstein²,

Connolly³

et al. 2012

FOC

278

326

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Carotid-cavernous fistulas (CCFs) are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. The characteristic clinical features seen in patients with CCFs are the sequelae of hemodynamic dysfunction within the cavernous sinus. Once routinely treated with open surgical procedures, including carotid ligation or trapping and cavernous sinus exploration, endovascular therapy is now the treatment modality of choice in many cases. The authors provide a review of CCFs, detailing the current classification and clinical management of these lesions. Therapeutic options including conservative management, open surgery, endovascular intervention, and radiosurgical therapy are presented. The complications and treatment results as reported in the contemporary literature are also reviewed.

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Section: Radiosurgical Interventionmentioning

confidence: 99%

Carotid-cavernous fistulas

Ellis¹,

Goldstein²,

Connolly³

et al. 2012

FOC

278

326

View full text Add to dashboard Cite

show abstract

“…the 'gamma knife') as well as conventional radiotherapy have been evaluated with the expectation of obliterating shunts within 12-36 months. 36 Hirai et al, 37 employing conventional radiotherapy in low-as well as medium-and high-flow dural CCFs, were successful in treating 75% of their patients, especially when embolization was combined with irradiation. Link et al 36 have presented the same favorable results in 72% of their patients treated with radiosurgery followed by embolization for intracranial and cavernous sinus fistulas along with intracranial hypertension.…”

mentioning

confidence: 99%

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

R¹

2003

Orbit

187

109

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The author investigated 101 cases with direct dural carotid-cavernous and orbital arteriovenous fistulas (CCF). The characteristic clinical findings, such as specific epibulbar arterialized loops, are described and the differential diagnosis of the striking diagnostic triad (exophthalmos, the above-mentioned loops and glaucoma) is discussed, together with the exclusion criteria for other causes of red eyes, episcleral measurements and blood flow. The results of various diagnostic procedures, such as ultrasonography, Doppler hematotachography and color Doppler of the orbit and carotid systems, magnetic resonance imaging and angiography, and of conservative treatment and embolization processes are dealt with successively. The classification of different types of carotid-cavernous fistulas is presented,(1-3) together with the clinical signs in relation to morbidity and mortality during or after conservative or intervention therapies. The importance of patient follow-up, in the clinic as well as with Doppler methods, is emphasized in order to differentiate a progressive or diminished clinical condition caused by spontaneous thrombosis in the healing process or more arteriovenous flow. A 'decision tree' for use in daily practice is provided. In this study, of the 101 cases in which the localization was diagnosed by angiography, 42 were direct (30 traumatic, 12 spontaneous), 31 were dural (3 traumatic, 28 spontaneous) and 10 were orbital CCFs. In 18 other cases, usually dural or orbital shunts, angiography was not performed. For the management of 42 direct fistulas, conservative treatment was used in 12 cases (7 with success; 58%) and balloon embolization was performed in 18 cases (17 with success; 94.5%); the other cases were treated by direct or indirect surgery. Of the 48 (spontaneous and traumatic) dural fistulas, 39 were treated conservatively (32 recovered or were much improved: 82%, of the total cases, 67%). All seven cases in which embolization was performed were cured and/or much improved. In two cases, one fistula was conservatively treated while one was embolized at another location, both with success. Of the 10 orbital arteriovenous shunts showing signs of dural fistulas, the features disappeared in 8 cases, although after a much longer follow-up period than for the typical dural carotid-cavernous sinus fistulas; in one patient, direct surgery was performed successfully and in one patient the original, non-progressive, orbital features could still be observed.

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“…El manejo de la FCC incluye: tratamiento endovascular (23,24), corrección quirúrgica directa (25), radioterapia (26), radiocirugía estereotáctica (27), compresión manual intermitente (28) y oclusión de la arteria carótida ipsilateral, de los cuales el tratamiento endovascular constituye el de elección en la mayoría de las fístulas Barrow A. En nuestro caso se aplicó la oclusión de la arteria carótida ipsilateral con el objetivo de disminuir el flujo sanguíneo hacia la fístula, obteniéndose mejoría de los síntomas oculares.…”

Section: Discussionunclassified

Fistula carótido-cavernosa unilateral con síntomas neuro-oftalmológicos bilaterales e infarto cerebral venoso: Reporte de un caso.

et al. 2017

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La fistula carótido-cavernosa es una comunicación anómala entre la arteria carótida y el seno cavernoso que provoca un shunt arteriovenoso patológico y cuyo origen es traumático o espontáneo. Las manifestaciones clínicas están relacionadas con el cambio de dirección del drenaje venoso y del flujo sanguíneo a través de la fístula e incluyen síntomas oculares tales como quemosis, exoftalmos y soplo orbitario, además de manifestaciones neurológicas como infartos venosos y hemorragias intracerebrales. Su presencia se confirma mediante la angiografía por sustracción digital (ASD) y la clasificación generalmente aceptada se basa en la propuesta por Barrow. El tratamiento endovascular ha sido el enfoque terapéutico preferido durante las últimas dos décadas; sin embargo, el tratamiento quirúrgico sigue siendo una opción cuando aquél falla o no está disponible. Se reporta el caso de una paciente de 71 años de edad, con antecedente de traumatismo cráneo-encefálico en la que se diagnósticó fístula carótido-cavernosa izquierda y síntomas neuro-oftalmológicos bilaterales asociados a un infarto venoso a nivel temporal izquierdo. La paciente fue intervenida quirúrgicamente y presentó una evolución clínica favorable.PALABRAS CLAVE: Fístula del seno cavernoso de la carótida, traumatismos de las arterias carótidas, infarto cerebral, exoftalmia. SUMMARYThe carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus that induces a pathological arterio-venous shunt, and whose origin may be traumatic or spontaneous. Its clinical symptoms are related to changes in the direction of the venous drainage and blood flow through the fistula, and include ocular symptoms as chemosis, exophthalmos and orbital murmur besides neurological manifestations such as venous infarctions and intracerebral hemorrhage. Its presence is confirmed by digital subtraction angiography and the generally accepted classification is based on Barrow'se proposal. Endovascular treatment has been the preferred treatment approach for the past two decades; however, surgical treatment remains an option when the former fails or is not possible. The case of a 71 year-old woman with a history of traumatic brain injury is reported: the patient was diagnosed with carotid-cavernous fistula and bilateral neuro-ophthalmic symptoms associated with left temporal venous infarction, and underwent surgical treatment with a favorable clinical outcome.

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Dural carotid cavernous fistulas: role of conventional radiation therapy--long-term results with irradiation, embolization, or both.

Abstract: Conventional radiation therapy resulted in cure of DCCFs in nine (75%) of the 12 patients and in improvement of signs and symptoms in one (8%). Fast-type DCCFs may not always be improved. Radiation therapy may be useful in DCCFs after embolization.

Cited by 22 publications

References 0 publications

Carotid-cavernous fistulas

Carotid-cavernous fistulas

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

Fistula carótido-cavernosa unilateral con síntomas neuro-oftalmológicos bilaterales e infarto cerebral venoso: Reporte de un caso.

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