[Treatment of carotid-cavernous fistulas via endovascular approaches]

Carotid cavernous fistulas are abnormal communications between the arterial system and the cavernous sinus. The patients present with pulsating exophthalmos, chemosis, and ophthalmoplegia.

Since 1995, eleven patients have been treated for carotid cavernous fistulas at Odense University Hospital using different endovascular approaches. Five of them were treated from the internal carotid artery, four with detachable balloons and one with Guglielmi detachable coils. Five patients were treated by venous approaches. In three cases, the superior ophthalmic vein was used, and in two the inferior petrosal sinus. One patient could not be treated.

Ten of the eleven patients were treated successfully. Two of the balloons deflated in a few weeks. In one of the patients the carotid artery was subsequently occluded without problems. The other was not treated again because of age (90 years) and partial relief of the symptoms. In the other eight patients, the symptoms disappeared or were relieved. There were no complications during the procedures. The best and most stable results were achieved by the venous approaches.

Endovascular treatment, especially the venous approach, should be the first choice in treating carotid cavernous fistulas.