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Published on: October 20, 2017
Management of dural carotid cavernous fistulas: a single-centre experience
Tiago Rodrigues1, Robert Willinsky, Ronit Agid
1Departamento de Neurorradiologia, Hospital de Santo António, Centro Hospitalar do Poro, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal, tyagorodrigues@gmail.com.
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.
