Diagnosis and treatment of dural carotid-cavernous fistulas: a consecutive series of 27 patients.
OBJECTIVE
To report clinical characteristics, angiographical findings and results of endovascular treatment of patients presenting with dural carotid-cavernous fistulas (DCCFs).


METHODS
Retrospective analysis of 27 consecutive patients with DCCF referred to a specialised interventional neuroradiology department.


RESULTS
Orbital and neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis (n = 25). The venous drainage of the fistula involved the ipsilateral superior ophthalmic vein in 24 patients, the contralateral cavernous sinus in 6 and a leptomeningeal vein in 5 patients. Thrombosis of at least one petrosal sinus was found in 23 patients. 7 patients did not receive endovascular treatment: 3 had spontaneous DCCF obliteration, and 4 had only minor clinical symptoms and no leptomeningeal venous drainage on an angiogram. 20 patients received endovascular treatment via either a transvenous (n = 16) or a transarterial approach (n = 4). Complete occlusion of the fistula was obtained in 14 of 16 (87%) patients treated by the transvenous approach and in 1 of 4 (25%) patients treated by the transarterial approach. 16 patients had early clinical improvement after endovascular treatment. One patient had a cerebral haemorrhage after transvenous embolisation of a DCCF with leptomeningeal drainage. On follow-up, all patients treated by the transarterial route remained symptomatic, whereas 10 of 14 (71%) patients cured by the transvenous route were asymptomatic.


CONCLUSIONS
Transvenous embolisation is a safe and efficient endovascular approach to treat patients with DCCF. However, this technique requires a long learning curve.
Théaudin
M
M
Service de Neurologie, Hôpital Lariboisière, Paris, France.
Saint-Maurice
J-P
JP
Chapot
R
R
Vahedi
K
K
Mazighi
M
M
Vignal
C
C
Saliou
G
G
Stapf
C
C
Bousser
M-G
MG
Houdart
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome