Carotid-Cavernous Fistulas: Pathogenesis and Routes of Approach to Endovascular Treatment

Harish Shownkeen; Davide Bova; Thomas C. Origitano; Guy J. Petruzzelli; John P. Leonetti

doi:10.1055/s-2001-16609

Skull Base, Inhaltsverzeichnis

Skull Base 2001; 11(3): 207-218
DOI: 10.1055/s-2001-16609

CASE REPORTS

Carotid-Cavernous Fistulas: Pathogenesis and Routes of Approach to Endovascular Treatment

Harish Shownkeen¹ , Davide Bova¹ , Thomas C. Origitano² , Guy J. Petruzzelli³ , John P. Leonetti³

¹ Department of Radiology, Loyola University Medical Center, Maywood, Illinois
²Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
³Department of Otolaringology, Loyola University Medical Center, Maywood, Illinois

Abstract

ABSTRACT

The etiology, classification, clinical presentation, complications, and intravascular routes to image and treat carotid-cavernous fistulas percutaneously are described. Endoarterial and transvenous approaches (through the jugular, inferior petrosal, or cavernous veins) are discussed in relation to the etiology, size, and characteristics of the fistulas, as well as in relation to the planned therapeutic approach and its possible complications. Possible outcomes, with particular attention to the internal carotid circulation, side effects, and complications also are discussed in relation to etiology and type of fistula. Four exemplary cases are presented.

KEYWORD

Carotid-cavernous sinus fistula - cerebral angiography - therapeutic embolization - balloon occlusion

Volltext

Referenzen

REFERENCES

1 Barrow D L, Spector R H, Braun I F. Classification and treatment of spontaneous carotid cavernous sinus fistulas. J Neurosurg . 1985; 62 248-256
2 Hirai T, Korogi Y, Baba Y. Dural carotid cavernous fistulas: role of conventional radiation therapy-long-term results with irradiation, embolization or both. Radiology . 1998; 207 423-430
3 Kupersmith M J, Satterfield D, Dublin A B. Dural and carotid cavernous sinus fistulas: diagnosis, management and complications. Ophthalmology . 1987; 94 1585-1600
4 Katsiotis P, Kiriakopolous C, Taptas J. Carotid-cavernous fistulae and dural arteriovenous shunts. J Vasc Surg . 1974; 8 60-69
5 Debrun G M, Lacour P, Vinuela F. Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg . 1981; 55 678-692
6 Vinuela F, Fox A J, Debrun G M. Spontaneous carotid-cavernous fistulas: clinical, radiological and therapeutic considerations. Experience with 20 cases. J Neurosurg . 1984; 60 976-984
7 Beylot C, Bioulac P, Doutre M S. Les manifestations arterielles du syndrome d' Ehlers-Danlos. Ann Med Intern . 1983; 134 451-457
8 Weis D J, Shaffer R N. Neovascular glaucoma complicating carotid-cavernous fistula. Arch Ophthalmol . 1963; 69 304-307
9 Grove Jr S A. The dural shunt syndrome: pathophysiology and clinical course. Ophthalmology . 1984; 91 31-44
10 Halbach V V, Hieshima G B, Higashida R T. Carotid cavernous fistulae: indications for urgent therapy. Am J Neurorad . 1989; 8 627-633
11 Keltner J L, Satterfield D, Dublin A B. Dural and carotid cavernous fistulas: diagnosis, management and complications. Ophtalmology . 1987; 94 1585-1600
12 Norman D, Newton T H, Edwards M S. Carotid-cavernous fistula: closure with detachable silicone balloons. Radiology . 1983; 149 149-159
13 Debrun G B, Lacour P, Fox A J. Traumatic carotid-cavernous fistulas: etiology, clinical presentation, diagnosis, treatment and results. Semin Intervent Radiol . 1987; 4 242-248
14 Lewis A I, Tomsick T A, Tew Jr M J. Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons. J Neurosurg . 1996; 84 400-404
15 Halbach V V, Higashida R T, Hieshima G B. Transvenous embolization of direct carotid cavernous fistulas. Am J Neuroradiol . 1988; 9 741-747
16 Manelfe C, Berenstein A. Treatment of carotid cavernous fistulas by venous approach: report of one case. J Neuroradiol . 1980; 7 13-19
17 Spinelli H M, Falcone S, Lee G. Orbital venous approach to the cavernous sinus: an analysis of the facial and orbital venous system. Ann Plast Surg . 1994; 33 377-384
18 Francis P M, Zabramski J M, Spetzler R F. Treatment of bilateral spontaneous dural carotid-cavernous fistula by coils and sclerotherapy. J Neurosurg . 1987; 66 468-470
19 Guglielmi G, Vinueal F, Briganti F, Duckwiler G. Carotid-cavernous fistula caused by a ruptured intracavernous aneurysm: endovascular treatment by electrothrombosis with detachable coils. Neurosurgery . 1992; 31 591-597

a Teng M M, Guo W Y, Lee L S, Chang T. Direct puncture of the cavernous sinus for obliteration of a recurrent carotid-cavernous fistula. Neurosurgery . 1988; 23 104-107
b Teng M M, Lirng J F, Chang T. Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure. Radiology . 1995; 194 705-711