Indications for Treatment and Classification of 132 Carotid-Cavernous Fistulas

Abstract

Classification of carotid-cavernous fistulas (CCFs) into the four types described by Barrow allows the surgeon to choose the optimal therapy for each patient. Type A patients have fast flow fistulas that are manifest by a direct connection between the internal carotid arterial siphon and the cavernous sinus through a single tear in the arterial wall. The best therapy is obliteration of the connection by a detachable balloon. Ninety-two of 95 traumatic CCFs were treated in this fashion. Direct surgical exposure of the cervical or cavernous internal carotid artery (ICA) was necessary in the remaining 3 patients, who had undergone unsuccessful surgical trapping. Three ruptured cavernous aneurysms and 2 spontaneous CCFs also had Type A connections. Other carotid-cavernous fistulas are slow flow, spontaneous dural arteriovenous malformations (AVMs) that have been classified into B, C, and D types on the basis of arterial supply. Occlusion of the ICA is not a logical choice in the treatment of dural AVMs that occur in the elderly, are relatively benign, and are often bilateral. Type B are rare and are fed by meningeal branches of the ICA only. We have not seen this type of dural fistula in our series. Type C are supplied by feeders from the external carotid only and can almost always be obliterated successfully by embolizing the external carotid artery (ECA) branches. There are 4 Type C cases in this series of 37 spontaneous CCFs. All occurred in patients less than 30 years of age and were shunts between the middle meningeal artery and the cavernous sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the Risk of Oculomotor Nerve Deficits between Detachable Balloons and Coils in the Treatment of Direct Carotid Cavernous Fistulas

“…Higashida et al 1 reported preservation of the parent ICA in 88% of patients with DCCFs treated by using detachable balloons, while other authors have described a need for parent artery occlusion in as many as 20% of cases. 2,3 In addition, straying, overinflation, or migration of a detached balloon may lead to deterioration of ocular palsy. 4 GDCs were previously used in cases in which the balloon technique failed.…”

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

“…Higashida et al [15] reported preservation of the parent artery in 88% of patients with TCCFs treated by using detachable balloons; other authors have described a need for parent artery occlusion in as many as 20% of cases [16,17].…”

Central Nervous System Vascular Malformations

“…DAVMs have been reported to occur in patients with various systemic conditions, particularly syndromes characterised by connective tissue disorders. Potential associations include: atypical Sturge-Weber related syndrome [114], blue rubber-bleb nevus syndrome [115], congenital toxoplasmosis [116], Ehlers-Danlos syndrome [117][118][119], fibromuscular dysplasia [117,120,121], hereditary hemorrhagic telangiectasia [122,123], Marfan's syndrome [124], osteogenesis imperfecta [117], polyarteritis nodosa [125], pseudoxanthoma elasticum [126], Rendu-Osler-Weber syndrome [127], syndactyly [128], and von Recklinghausen's disease [129].…”