Jordán GJ, Vázquez LF, Luna CCM, Santos MÁM, Marrero MM, Piñera MJ

Language: Spanish
References: 12
Page:
PDF size: 309.35 Kb.

ABSTRACT

Introduction. Carotid cavernous fistulae are abnormal communication between the carotid artery or its branches and the cavernous sinus. They can be classified as high flow or low flow fistulae, and traumatic or spontaneous. Symptoms are most frequently eye related due to the increased retrograde blood flow into the superior ophthalmic vein. They can be treated endovascularly, via trans arterial or trans venous. Occlusion can be achieved with coils, embolizing polymers or both combined. Methods. 18 patients with carotid cavernous fistulae were treated endovascularly between 2010 and 2017, in the Neurointerventional Department of Surgical Medical Research Center. Of them 12 patients presented with direct fistulae and 6 with indirect fistulae. All direct fistulae were treated with 10 or 18 coils. Trans arterial approach with Histoacryl injection was used in 5 patients with indirect fistulae, in 1 patient trans venous approach was performed successfully. Results: Total occlusion was achieved in all 18 patients, one of them required 2 sessions. An unexpected, well tolerated, sudden carotid occlusion occurred in 2 patients, in whom 18 coils were used. Conclusions: Endovascular treatment with embolization of carotid cavernous fistulae is a feasible and safe procedure in cuban patients. High rates of total occlusion can be achieved. Unexpected carotid occlusion was associated with 18 coils placement.

REFERENCES

1. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT: Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985; 62:248–256.

2. Borba LAB, Al-Mefty O: Normal anatomy of the cavernous sinus, in Eisenberg MB, Al-Mefty O (eds): The Cavernous Sinus: A Comprehensive Text. Philadelphia: Lippincott Williams & Wilkins, 2000, pp 21–34

3. Stiebel-Kalish H, Setton A, Nimii Y, Kalish Y, Hartman J, Huna Bar-On R, et al: Cavernous sinus dural arteriovenous malformations: patterns of venous drainage are related to clinical signs and symptoms. Ophthalmology. 2002; 109:1685– 1691,

4. de Keizer R: Carotid-cavernous and orbital arteriovenous fitulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit. 2003; 22:121–142.

5. Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg. 1974; 41:125-145.m

6. Gomez AM, Gomez JF, Anaya CA. Treatment of carotid cavernous fistulas using covered stents: midterm results in seven patients. Am J Neuroradiol. 2007; 28(9):1762-1768.

7. Klisch J, Huppertz HJ, Spetzger U, et al. Transvenous treatment of carotid cavernous and dural arteriovenous fistulae: results for31 patients and review of the literature. Neurosurgery 2003;53 836-856.

8. Arat A, Cekirge S, Saatci I, Ozgen B. Transvenous injection of Onyx for casting of the cavernous sinus for the treatment of a carotid-cavernous fistula. Neuroradiology. 2004; 46(12):1012- 1015.

9. Korkmazer B, Kocak B, Tureci E, Islak C, et al. Endovascular treatment of caroti cavernous sinus fitula: a systemati review. World J Radiol 2013;5:143-155.

10. Gonzalez LF, Chalouhi N, Tjoumakaris S, Jabbour P, Dumont AS, Rosenwasser RH (2012) Treatment of carotid-cavernous fistulas using intraarterial balloon assistance: case series and technical note. Neurosurg Focus 32(5):E14

11. Luo CB, Teng MM, Chang FC, Chang CY (2006) Transarterial balloon-assisted n-butyl-2-cyanoacrylate embolization of direct carotid cavernous fistulas. AJNR Am J Neuroradiol 27(7): 1535–1540.

12. Jordán J, Llibre JC, Vázquez F, Marino R, Ugarte JC, Prince JA. Terapia endovascular cerebral en las malformaciones arteriovenosas cerebrales. Invest Medicoquir 2012;4(1):12-19.