[Treatment of carotid cavernous fistulas].
BACKGROUND
Carotid-cavernous fistulas (CCF) are anomalous communications between the carotid arterial and carotid venous circulation of the cavernous sinus. The arterio-venous shunt leads to increased congestion of the orbit and causes the characteristic clinical picture typical of this condition; medusa's head, proptosis, raised intra-ocular pressure and tinnitus.


METHODS
Classically, acute onset of these signs after trauma has been considered to be due to CCF. However, 25% of CCF are low flow and have an insidious clinical course which is concealed and difficult to diagnose. Primary search depends initially on the use of ultra-sound (Eco-B and Eco-Doppler). In doubtful cases vascular study is done using non-invasive methods such as angio-CT, angio-MR and Divas. Intra-arterial angiography is left until the preoperative study is done.


CONCLUSIONS
Whilst 90% of medium and high flow FCC require neurosurgical treatment for the gravity of the symptoms, only 25% of the low flow FCC require it. The latter are initially treated conservatively.
Montané
D
D
Centro de Oftalmología Barraquer, Barcelona, España.
Casado
J
J
D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D014463:Ultrasonography; D016157:Vascular Fistula / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
Tratamiento de las fístulas carótido-cavernosas.