Endovascular management of dural fistulas into the cavernous sinus. A systematic review

Abstract

Background: Dural fistula to the cavernous sinus (DFCS) is an infrequent pathology that consists in the anomalous communication between the meningeal branches of the internal carotid artery (ICA) and/or the external carotid artery (ECA) and the cavernous sinus.Aim: To perform a systematic review to evaluate clinical and imaging findings in DFCS, and current indications for treatment.Methods: A literature search was performed in several medical databases using the keywords "intracranial dural fistula", "carotid-cavernous fistula", "endovascular treatment", associated with "outcome"; resulting articles were assessed by considering factors such as: number of patients treated, type of material used, complications, and type of image technique used for diagnosis.Results: 33 articles were selected, yielding: clinical and imaging: The symptoms are basically related to the type of venous drainage

Carotid cavernous fistula (CCF) with coil embolization in interventional radiology: A case report

“…Postmenopausal women are also reported to frequently experience indirect CCF [2] . Indirect CCF processes in the postmenopausal group often occur typically and spontaneously [3] . However, this condition can also occur in other age groups due to pregnancy, sinusitis, or cavernous sinus thrombosis [3] .…”

“…Indirect CCF processes in the postmenopausal group often occur typically and spontaneously [3] . However, this condition can also occur in other age groups due to pregnancy, sinusitis, or cavernous sinus thrombosis [3] . The exact mechanism by which CCF spontaneously causes is unknown.…”

“…DSA is the procedure of choice to accurately define vascular architecture to assess the presence of an injured process and pattern of vascular drainage [3] . Angiographic evaluation of DSA is carried out in 2 phases, diagnostic catheterization and super selective catheterization.…”

“…Direct fistulas (type A in Barrow's classification) are usually caused by penetrating or blunt trauma. In contrast, indirect fistulas (types B, C, and D in Barrow's classification) are generally caused by nontraumatic conditions such as hypertension, fibromuscular dysplasia, type IV Ehlers-Danlos and internal carotid artery dissection [3] . The clinical presentation in patients with CCF is often associated with ophthalmic disturbances, such as ophthalmic monoplegia, ptosis, loss of sensation in the distribution area of the trigeminal nerve, exophthalmos, facial pain, chemosis, Horner's syndrome, and headache [4] .…”

“…Digital subtraction angiography (DSA) is a method for determining the condition of blood vessels by assessing whether there are abnormal conditions [3] . The main goal in treating CCFs is maintaining the integrity of the flow in the internal carotid artery.…”