Management of Dural Carotid Cavernous Fistulas: a Single-centre Experience

Overview

Journal Eur Radiol

Specialty Radiology

Date 2014 Jul 21

PMID 25038862

Citations 8

Authors

Tiago Rodrigues

Robert Willinsky

Ronit Agid

Karel Terbrugge

Timo Krings

Affiliations

Soon will be listed here.

Abstract

Objectives: To report the epidemiological features, clinical presentation, angiographic characteristics and therapeutic options, success and complication rates in patients with dural carotid cavernous fistulas (dural CCFs).

Methods: Retrospective evaluation of patients followed in our institution between January of 2005 and September of 2013.

Results: There were 38 patients, 76 % females, with an average age of 63 years. Ocular symptoms and signs were the most frequent clinical findings. Dural CCFs were Barrow type B in 8%, type C in 10% and type D in 82%. Cortical venous reflux was present in 50% of cases. Medical treatment was performed in 16% of patients, external ocular compression in 8%, transarterial embolisation in 13%, transvenous embolisation in 60% and radiosurgery in 3%. Clinical and angiographic follow-up data were available in 89% and 82% of patients with a mean follow-up time of 9 and 7 months, respectively. Clinical cure was achieved in 58% of patients and improvement in 24%. Anatomical cure was demonstrated in 68%. Transient worsening or new onset of ocular symptoms was observed in 29%. There was no permanent morbidity or mortality.

Conclusions: In properly selected patients, endovascular embolisation, particularly by transvenous approach, represents a safe and effective treatment for dural CCFs.

Key Points: Dural carotid cavernous fistulas are more common in elderly women. Dural CCFs most commonly present with ocular symptoms and signs. Endovascular treatment is effective and safe in properly selected patients.

Citing Articles

Endovascular approaches for the treatment of dural carotid-cavernous fistulas: A systematic review.

Harake E, Nieblas-Bedolla E, Wilseck Z, Chaudhary N, Armonda R, Pandey A Interv Neuroradiol. 2024; :15910199241272595.

PMID: 39113637 PMC: 11571140. DOI: 10.1177/15910199241272595.

Transvenous Approaches to Embolization of Dural Arteriovenous Fistulae of the Cavernous Sinus.

Guest W, Krings T J Neuroendovasc Ther. 2023; 16(2):63-73.

PMID: 37502647 PMC: 10370966. DOI: 10.5797/jnet.ra.2021-0001.

Clinical efficacy of endovascular treatment approach in patients with carotid cavernous fistula: A systematic review and meta-analysis.

Rahmatian A, Yaghoobpoor S, Tavasol A, Aghazadeh-Habashi K, Hasanabadi Z, Bidares M World Neurosurg X. 2023; 19:100189.

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What is the most effective method to treat indirect carotid-cavernous fistula?.

Voldrich R, Charvat F, Benes V, Netuka D Neurosurg Rev. 2022; 46(1):9.

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Bilateral Carotid-cavernous Fistulas Treated with Partial Embolization and Radiosurgery.

Briggs R, Bonney P, Algan O, Patel A, Sughrue M Cureus. 2019; 11(10):e5886.

PMID: 31772856 PMC: 6837273. DOI: 10.7759/cureus.5886.

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