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Bilateral Carotid-cavernous Fistulas Treated with Partial Embolization and Radiosurgery
Robert G Briggs1, Phillip A Bonney2, Ozer Algan3
1Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Cureus
|November 28, 2019
Summary
Bilateral carotid-cavernous fistulas (CCFs) are rare vascular conditions. This case highlights successful multimodal management using radiosurgery after failed embolization for Barrow grade D CCFs.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Surgery
Background:
- Bilateral carotid-cavernous fistulas (CCFs) are uncommon, potentially leading to significant visual impairment.
- Barrow grade D CCFs represent a challenging subset requiring complex management strategies.
Observation:
- An 88-year-old woman presented with a two-month history of progressive visual decline.
- Imaging revealed bilateral carotid-cavernous fistulas, classified as Barrow grade D.
Findings:
- Conventional endovascular embolization via angiography was technically unsuccessful in achieving complete closure.
- Adjuvant stereotactic radiosurgery was employed as a salvage treatment modality.
Implications:
- This case underscores the potential efficacy of radiosurgery in managing complex, treatment-resistant CCFs.
- Multimodal approaches combining endovascular techniques and radiosurgery may be crucial for optimizing outcomes in challenging CCF cases.
