To describe the classification, imaging features (CT, MRI, DSA), etiology, clinical presentation and the approach to endovascular treatment of CCF´s.

Introduction: CCF is an abnormal communication between carotid arterial system (Internal Carotid Artery -ICA- or External Carotid Artery -ECA-) and cavernous sinus (CS) (Fig. 1). Increased pressure within the CS seems to be the mainstay of pathophysiology, although arterial steal and increased flow plays an important role. Classification and etiology: There are several classifications of CCF´s, according to its etiology (traumatic or spontaneous), flow dynamics (high or low flow) and anatomy (direct or indirect). Barrow et al [1] made a classification based on their arterial...

CT and MRI are the preferred non-invasive imaging techniques in diagnostic approach of CCF. CT scan can depict proptosis, enlargement of the extraocular muscles, dilatation and tortuosity of ophthalmic veins (mainly superior ophthalmic vein -SOV-), and enlargement of the ipsilateral cavernous sinus, with bulging of its lateral wall. A noncontrast cranial CT scan must be done in order to search skull fractures or intracranial haemorrhages [3]. MR images show similar findings to those seen on CT; also depicts orbital edema, enlarged pituitary gland (due to...

CCF is an uncommon pathology that must be suspected by the radiologist in setting of trauma or in the appropriate clinic context. Careful examination of the CT/MRI can yield an early diagnosis and prompt treatment. DSA remains the gold standard for diagnosis and treatment. Low-flow indirect fistulas (types B, C and D) can be conservatively managed and those with dangerous drainage patterns and high-flow direct (type A) fistulas require adequate treatment. With recent advances, endovascular therapy has become the most used therapy in management of...

Daniel Rodriguez Bejarano MD, Radiology Resident, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat (Barcelona); [email protected] Lucia Aja Rodriguez MD, Department of Neuroradiology, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat (Barcelona); [email protected] Paloma Mora Montoya MD,Department of Neuroradiology, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat (Barcelona); [email protected] Lisbeth Valoyes Guerrero MD,Radiology Resident, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat (Barcelona); [email protected] Maria Angeles de Miquel Miquel MD,Department of Neuroradiology, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat (Barcelona); [email protected] Angels Camins Simon MD, Radiologist. Institut de Diagnostic...

Barrow DL, Spector RH, Braun IF el al. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg.1985; 62(2):248-56. Liang W, Xiaofeng Y, Weiguo L, Wusi Q, Gang S, Xuesheng Z. Traumatic carotid cavernous fistula accompanying basilar skull fracture: a study on the incidence of traumatic carotid cavernous fistula in the patients with basilar skull fracture and the prognostic analysis about traumatic carotid cavernous fistula. J Trauma. 2007; 63(5):1014-20. Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid...