Learning objectives
Review the Barrow classification according to its anatomical and etiological correlation.
Describe clinical and radiological findings of the carotid-cavernous fistulas.
To propose therapeutic alternatives focusing on endovascular therapeutic approach.
Background
Carotid-cavernous fistulas (CCF) are an abnormal communication between the carotid circulation and the cavernous sinus that alters the usual drainage flow.
According to flow parameters, they can be classified into direct high-flow CC fistulas, consisting of a defect in the wall of the internal carotid artery (ICA), causing a shunt between the ICA and the cavernous sinus (normally by a traumatic or spontaneous event for the ruptured cavernous segment aneurysm) and the indirect ones, low-flow CCF, which are equivalent to dural arteriovenous fistulas (dAVFs) of...
Findings and procedure details
AngioCT and angioMRI are the initial radiological modalities of suspicion for CCF. They are non-invasive tests that can show indirect signs of CCF, such as orbital congestion and venous engorgement (Table1).
However, DSA is necessary for the confirmation diagnosis, since it gives us the anatomy of the arteriovenous fistula feeding vessels and hemodynamic information on aberrant drainage pathways. This allows us to classify the CCF and plan the treatment of endovascular intervention.
The diagnostic test should include the bilateral selective catheterization of both ICA, ECA...
Conclusion
DSA is the gold-standard technique in the diagnosis of carotid-cavernous fistulas, giving us a vascular mapping that allows planning of the endovascular approach, the latter being the treatment of choice with low-risk and better results than surgery.
Personal information and conflict of interest
I. Martinez Gonzalez; Cáceres/ES - nothing to disclose I. Díaz Villalonga; Cáceres/ES - nothing to disclose L. Ortiz Evan; Cáceres/ES - nothing to disclose A. Tirado Muñoz; Cáceres/ES - nothing to disclose P. A. Parra Ramirez; Cáceres/ES - nothing to disclose
References
Mark R. Harrigan John P. Deveikis. Handbook of Cerebrovascular Disease and Neurointerventional Technique. 3rd ed. Humana Press; 2009. p. 76-93, 366-374, 765-769.
G. Benndorf. Dural Cavernous Sinus Fistulas. Diagnosis and Endovascular Therapy. Medical Radiology Diagnostic Imaging; 2010.
Classification and treatment of spontaneous carotid cavernous sinus fistulas. Barrow et al. Journal of Neurosurgery; 1985. num. 62.
Clayton Chi-Chang Chen, Patricia Chuen-Tsuei Chang, Cherng-Gueih Shy, Wen-Shien Chen and Hao-Chun Hung. CT Angiography and MR Angiography in the Evaluation of Carotid Cavernous Sinus Fistula Prior to Embolization: A...
