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Treatment of carotid cavernous fistulas.
MedLine Citation:
PMID:  20842489     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
The treatment of a carotid cavernous fistula (CCF) depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. In most instances, endovascular treatment is preferred.High-flow direct CCFs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. They usually present with sudden development of a clinical triad: exophthalmos, bruit, and conjunctival chemosis. All direct CCFs should receive treatment, because they carry a high probability of intracranial hemorrhage or neurologic deterioration.Low-flow indirect or dural CCFs, either incidental or with minimal symptoms, are not associated with significant risk of intracranial hemorrhage. The accepted practice is to treat ocular symptoms conservatively with medical management or manual carotid compression. If the patient cannot tolerate the symptoms, or if signs of ocular morbidity occur, endovascular treatment is offered.The first treatment option should be endovascular embolization with a combination of detachable balloons, coils, stents, or liquid embolic agents. The procedure can be performed from either an arterial or venous approach. Use of these materials and techniques can yield a high cure rate with minimal complications.If the patient is not amenable to embolization or if the embolization fails, then surgery (surgical ligation of the internal carotid artery or packing of the cavernous sinus) should be offered.Stereotactic radiosurgery may be an elective treatment for low-flow CCFs, but it has no role in the treatment of high-flow CCFs.
Authors:
Joseph J Gemmete; Neeraj Chaudhary; Aditya Pandey; Sameer Ansari
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in neurology     Volume:  12     ISSN:  1534-3138     ISO Abbreviation:  Curr Treat Options Neurol     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2011-07-14     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  9815940     Medline TA:  Curr Treat Options Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  43-53     Citation Subset:  -    
Affiliation:
Division of Interventional Neuroradiology, Department of Radiology, University of Michigan, UH B1 D328, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5030, USA, gemmete@med.umich.edu.
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