Neuro-ophthalmic features of carotid cavernous fistulas and their treatment by endoarterial balloon embolisation.

Brosnahan, Donal; McFadzean, Robert M.; Teasdale, E.

doi:10.1136/jnnp.55.7.553

Cited by 26 publications

(21 citation statements)

References 16 publications

(3 reference statements)

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“…Unlike brain cerebral arteriovenous malfomations, they are acquired lesions. Because of direct shunting of arterial blood into the cavernous sinus and subsequently into the superior ophthalmic vein, they often present with pulsatile exophthalmos, diplopia, raised intraocular pressure, and intracranial hemorrhage if shunting occurs retrograde into the adjacent cerebral veins [1,2,3]. In the Barrow classification [4], direct or type A fistulas are due to a breach in the wall of the cavernous carotid artery leading to shunting of blood into the cavernous sinus.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Resolution of Post-Traumatic Direct Carotid-Cavernous Fistula

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Spontaneous Resolution of Post-Traumatic Direct Carotid-Cavernous Fistula

et al. 2017

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“…2,4,14 The treatment of dural CCFs is more complicated, however, and a variety of endovascular methods, both transarterial and transvenous, have been described for such cases. 2,4,14 The treatment of dural CCFs is more complicated, however, and a variety of endovascular methods, both transarterial and transvenous, have been described for such cases.…”

mentioning

confidence: 99%

Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach

Miller

Monsein

Debrun

et al. 1995

Journal of Neurosurgery

147

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The authors describe the method and results of treatment of 12 consecutive patients with carotid-cavernous sinus fistulas (CCFs). Treatment was by embolization via a transvenous approach through the superior ophthalmic vein (SOV). The CCFs (two direct and 10 dural) had previously been treated unsuccessfully or, for mechanical reasons, could not be treated by the standard techniques of endoarterial balloon occlusion, particle or glue embolization of feeding vessels from one or both external carotid arteries, or transvenous occlusion of the fistula via the ipsilateral inferior petrosal sinus. All 12 patients were successfully treated either by advancement of a detachable balloon catheter through the ipsilateral SOV into the cavernous sinus with subsequent inflation and detachment of the balloon (11 patients) or by introduction of multiple thrombogenic coils into the fistula via the ipsilateral SOV (one patient). All patients had complete resolution of symptoms and signs after successful occlusion of the CCF. There were no intraoperative complications; however, one patient required postoperative embolization of a residual posteriorly draining fistula via the ipsilateral external carotid artery, and another developed a persistent abducens nerve paresis that eventually required surgical correction. Ten (83.3%) of the 12 patients underwent cerebral angiography 3 to 6 months after surgery, and none showed evidence of a recurrent fistula. Similarly, none of the 12 patients developed recurrent symptoms and signs suggesting recurrence of the fistula during a follow-up period that ranged from 6 months to 10 years (mean 64 months). It is concluded that the transvenous approach to the cavernous sinus through the SOV is a safe and effective treatment of both direct and dural CCFs that are not amenable to transarterial or other transvenous approaches.

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“…Permanent CNP were reported early on as a complication in 16%-63% of patients with initial CNP after the use of balloon embolization to treat cavernous sinus fistulas. [22][23][24] The reported percentages of permanent CNP after coil embolization are comparable to treatment with balloons. However, the comparability of the studies is limited by the different outcome definitions and the described details of ocular symptoms.…”

Section: Discussionmentioning

confidence: 97%