Surgical Treatment of Carotid-Cavernous Fistulas

Arutiunov, A.I.; Serbinenko, F A; Shlykov, A A

doi:10.1016/s0079-6123(08)61495-8

Cited by 14 publications

(3 citation statements)

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“…The cure rate was 98-6% but one patient died as result of the procedure. To eliminate the intracranial clipping, Arutiunov et al (1968) developed their technique consisting of the cervical intraluminal placement of a clipped muscle embolus attached to a nylon string. The muscle is allowed to ascend under x-ray control to the intracavernous portion of the carotid artery and then secured in place by anchoring the nylon string to the internal carotid artery ligation.…”

Section: Discussionmentioning

confidence: 99%

“…Since then a limited number of artificial embolizations with surgical (Hamby and Gardner, 1933; Gurdjian, 1938;Rottgen, 1948;Jaeger, 1949;Jaeger, 1959;Sunder-Plassmann and Tiwisina, 1952;Hamby, 1964;674 Hamby, 1966;Kosary, Lerner, Mozes, and Lazar, 1968;Arutiunov, Serbinenko, and Shlykov, 1968) or accidental (Lang and Bucy, 1965) occlusion of the internal carotid artery in the neck, preceded in some with an intracranial carotid clipping, have been reported. Nonetheless all of these reported cases had a reduction of the ipsilateral carotid flow either due to the internal carotid ligation following the embolization or to post-operative carotid thrombosis.…”

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confidence: 99%

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Artificial embolization of carotid-cavernous fistula with post-operative patency of internal carotid artery

Isamat

Salleras

Miranda

1970

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY This report deals with a patient of 86 who developed a carotid-cavernous fistula. Artificial embolization alone was considered the safest treatment for this patient and proved to be adequate. Post-operative preservation of the patency of the internal carotid artery was demonstrated by angiography. We believe this method is particularly appropriate for carotid-cavernous fistulas if it is demonstrated by angiography that the major blood flow of the carotid artery pours into the fistula. A soft-iron clip attached to the muscle can be used for external and forceful guidance of the embolus into the fistula with the help of an electromagnet, hence the patency of the internal carotid artery can be preserved. The embolus should be introduced through the external carotid artery. This is the only case known to us in which patency of the internal carotid artery was postoperatively maintained. We have reviewed 545 reported cases of surgically treated carotid-cavernous fistulas and analysed the results from simple cervical carotid ligation to the more sophisticated methods of artificial embolizations. The results obtained by artificial embolization have been consistently good, while the other techniques have failed in large percentages. Artificial embolization should be used as the primary treatment for carotid-cavernous fistula, since ligation of the internal carotid artery precludes its embolization at a later date.Because of the dramatic and intense disability produced by a carotid-cavernous fistula this intracranial vascular pathology has had considerable surgical attention in spite of the low rate of incidence. A variety of surgical techniques have been developed but most of the surgical approaches have dealt with a distant reduction of the blood flow into the fistulous tract rather than with the closure of the fistula itself. Examples are the single or combined ligation of the carotid arteries in the neck and isolation of the fistula between an intracranial carotid clip and a cervical carotid ligation, the so-called 'trapping' operation.The first attempt to treat a carotid-cavernous fistula with a physiological approach to the problem was that of Brooks (1930) who successfully performed a muscle embolization of the intracavernous portion of the carotid artery. Since then a limited number of artificial embolizations with surgical (Hamby

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Artificial embolization of carotid-cavernous fistula with post-operative patency of internal carotid artery

Isamat

Salleras

Miranda

1970

Journal of Neurology, Neurosurgery & Psychiatry

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show abstract

“…Most subsequent authors of that time all quote ‘Brooks' method of muscle embolization.’ Sedzimir and Occleshaw15 ‘operation of muscle embolization — Brooks' method.’ Ishimori et al 16 state that ‘Brooks was considered to be the first to have carried out occlusion of the carotid-cavernous fistula with thrombus-making material.’ Kosary et al 17 quote ‘successful treatment of a case by muscle embolization alone by Brooks.’ Arutinnov et al 18: ‘Original Brooks operation has one important drawback: the muscular embolus is not controlled.’ Riechert,19 ‘Introduction of a small embolus of muscle after Brooks.’ Wanissorn20 quotes ‘The intraluminal embolization method of Brooks.’…”

Section: Pre-balloon Eramentioning

confidence: 99%