title: [Direct approach to carotid cavernosa fistula type of arterio venous dural malformation. Case report and review of the literature].
abstract: OBJECTIVE
  Barrow's D type carotid cavernosa fistula (FCC) with progressive symptoms and in whom endovascular procedures have failed meet criteria for a direct approach. We report a case of this type of vascular lesion in whom partial endovascular embolization was done together with a direct approach to the FCC, using a method of localization involving a transoperative imaging guide. Digital subtraction angiography and Estereoflex stereotactic system was used.
  
  
  METHODS
  A female patient had had a previous minor head injury. She had a progressive neurological disorder with marked visual defect, and had been diagnosed on angiography as having FCC with afferents from branches of the internal carotid artery (ACI) and external carotid artery (ACE). After failure of endovascular treatment orbito zygomatic craniotomy was done with extra intradural dissection and exposure of the antero lateral triangle of the cavernous sinus (SC). The fistula was closed completely by anterior packing with the venous component. Transoperative stereotactic angiographic checks were done to localize and control the packing.
  
  
  CONCLUSIONS
  The Barrow's type D FCC in which embolization treatment has failed may be treated using a direct approach to the anterolateral triangle of the SC. The AC1 remained permeable, fistula was occluded and there was minimal morbidity.
authors.affiliation: Servicio de Neurocirug a; Centro Internacional de Restauraci n Neurol gica (CIREN), La Habana, 11300, Cuba. gerardolf@yahoo.es
authors.forename: G
authors.initials: G
authors.lastname: Ló pez Flores
authors.forename: R
authors.initials: R
authors.lastname: Fernández-Melo
authors.forename: E
authors.initials: E
authors.lastname: Guerra-Figueredo
authors.forename: J
authors.initials: J
authors.lastname: Figueredo- Méndez
authors.forename: A
authors.initials: A
authors.lastname: Padrón Sánchez
authors.forename: J
authors.initials: J
authors.lastname: Teijeiro Amador
authors.forename: W
authors.initials: W
authors.lastname: Bouza-Molina
authors.forename: J M
authors.initials: JM
authors.lastname: Morales
authors.forename: O
authors.initials: O
authors.lastname: Cruz-Garc a
authors.forename: J
authors.initials: J
authors.lastname: Jordand
authors.forename: C
authors.initials: C
authors.lastname: Ugarte
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D004388:Dura Mater / Q000098:blood supply* / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008866:Microsurgery; D019635:Neurosurgical Procedures / Q000379:methods; D013238:Stereotaxic Techniques