Endovascular Treatment of Carotid-Cavernous Fistulas: Review of 12 Cases

Abstract

Carotid-cavernous fistulas (CCFs) are an uncommon pathology in current neurosurgical practice. Furthermore, they generally present a challenge to the neurosurgeon because of both their deep location and the major neurovascular structures that surround them. CCFs consist of a vascular anomaly in which blood flows from meningeal branches of the internal and external carotid arteries, or directly from the internal carotid artery, into the venous circulation around and in the cavernous sinus. Twelve patients with direct and indirect/dural CCFs who underwent examination and treatment between July 2003 and February 2006 are reported here. All patients of this retrospective evaluation were symptomatic at the time of diagnosis, which was confirmed by cerebral angiography. The patients were treated by endovascular approaches and the CCFs were occluded. From our evaluation, we concluded that the endovascular procedure is safe, effective and minimally invasive in patients with CCF.

Direct carotid-cavernous fistula presenting with minimal symptoms and rapid angiographic progression

“…[16][17][18][19] Some authors advocate conservative management with careful follow-up for minimally symptomatic patients with CCFs. 16 Given the high-flow nature of this lesion and the vascular steal phenomenon on repeat angiography, we felt that intervention was indicated for our patient.…”