Endovascular treatment of carotid cavernous fistulas in the area of cavernous sinus

Abstract

Background. Assessment of endovascular methods possibilities in the treatment for carotid-cavernous fistulas.Material and methods. The results of endovascular treatment in 22 patients with carotid-cavernous fistulas in the period from 2008 to 2018 were evaluated. The number of male patients was 13 (59%), female patients – 9 (41%). Fifteen patients (68%) had traumatic damage, 7 patients developed a spontaneous disease. All patients had a specific clinical features of carotid-cavernous fistula, confirmed by anamnesis and angiographic study. After verification of the diagnosis, all patients underwent permanent transcatheter embolization of the pathological connection using detachable balloons, microspirals and adhesive composition. Results. Twenty-one patients (95.5%) underwent one-stage embolization of carotid-cavernous fistulas. One patient (4.5%) required three procedures: two embolization with detachable balloons, final embolization with detachable spirals, due to deflation of the balloons in the early postoperative period. Destructive embolization of carotid-cavernous fistulas was performed in 2 cases (9%), reconstructive interventions were performed in 20 cases (91%). The angiographic success of the procedure was 100%. All treated patients had regression of symptoms during their hospital stay. During this period, one complication was identified in the form of post puncture hematoma, which required conservative treatment.Conclusion. Endovascular treatment is a modern, effective and safe method for treating carotid-cavernous fistulas. Destructive occlusion (if there is no possibility of performing reconstructive intervention) is also a safe and clinically justified method for treating this pathology.

Keywords

• carotid-cavernous fistulas
• embolization
• cavernous sinus
• vena ophthalmica superior
• fistula