title: Endovascular treatment of carotico-cavernous fistulas with acrylic glue: a series of nine cases.
abstract: BACKGROUND
  Injuries to the internal carotid artery close to the cavernous sinus may result in a fistulous connection between the artery and the venous sinus. Symptoms include pulsatile tinnitus, intracranial bruit, ophthalmological symptoms, and risk of intracerebral hematoma in cases of cortical venous reflux. Previous treatment strategies have included detachable latex balloons, coils, covered stents, or combinations thereof. Today, detachable latex balloons are phased out or withdrawn from several markets. Acrylic glue is a proven stable material used for embolization of arteriovenous shunts. It is a precise, fast, and cost-effective method of endovascular embolization, and it does not cause artifacts on MRI or MRA.
  
  
  METHODS
  We treated nine patients suffering from direct fistulas with acrylic glue without any permanent neurological adverse events.
  
  
  RESULTS
  Four patients were treated with glue embolization of the fistula without occlusion of the parent artery. Five patients with long-lasting symptomatology, large tears in the ICA, and with full collateral cerebral circulation were treated with glue embolization of the fistula and sacrifice of the ICA antero- and retrograde via the ICA and the posterior communicating artery.
  
  
  CONCLUSIONS
  We suggest acrylic glue to be added to the panel of embolic materials used to treat CCFs.
authors: Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, 92151, France. marcus.ohlsson@karolinska.se.|Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden. marcus.ohlsson@karolinska.se.
authors: Marcus
authors: http://orcid.org/0000-0002-1577-5509
authors: M
authors: Ohlsson
authors: Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, 92151, France.
authors: Arturo
authors: A
authors: Consoli
authors: Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, 92151, France.
authors: Georges
authors: G
authors: Rodesch
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging* / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013812:Therapeutics; D014014:Tissue Adhesives / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D006490:Hemostatics; D014014:Tissue Adhesives
keywords: Carotico-cavernous fistula; Cavernous sinus; Collagen disease; Ehlers-Danlos; NBCA