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Endovascular approaches for the treatment of dural carotid-cavernous fistulas: A systematic review.
Harake, Edward S; Nieblas-Bedolla, Edwin; Wilseck, Zachary; Chaudhary, Neeraj; Armonda, Rocco A; Pandey, Aditya S; Dowlati, Ehsan.
Afiliación
  • Harake ES; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
  • Nieblas-Bedolla E; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
  • Wilseck Z; Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
  • Chaudhary N; Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
  • Armonda RA; Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
  • Pandey AS; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
  • Dowlati E; Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
Interv Neuroradiol ; : 15910199241272595, 2024 Aug 08.
Article en En | MEDLINE | ID: mdl-39113637
ABSTRACT

INTRODUCTION:

Dural carotid-cavernous fistulas (dCCFs), also known as indirect carotid-cavernous fistulas, represent abnormal connections between the arterial and venous systems within the cavernous sinus that are typically treated via endovascular approach. We aim to investigate the clinical characteristics of patients with dCCFs based on the endovascular treatment approach and assess angiographic and clinical outcomes.

METHODS:

A systematic review of the literature was performed. Data including number of patients, demographics, presenting clinical symptoms, etiology of fistula, Barrow classification, and embolization material were collected and evaluated. Outcome measures collected included degree of fistula occlusion, postoperative symptoms, complications, and mean follow-up time.

RESULTS:

A total of 52 studies were included examining four primary endovascular approaches for treating dCCFs transarterial, transfemoral-transvenous (transpetrosal or other), transorbital (percutaneous or via cutdown), and direct transfacial access. Overall data was collected from 736 patients with 817 dCCFs. Transarterial approaches exhibit lower dCCF occlusion rates (75.6%) compared to transvenous techniques via the inferior petrosal sinus (88.1%). The transorbital approach via direct puncture or surgical cutdown offers a more direct path to the cavernous sinus, although with greater complications including risk of orbital hematoma. The direct transfacial vein approach, though limited, shows up to 100% occlusion rates and minimal complications.

CONCLUSION:

We provide a comprehensive review of four main endovascular approaches for dCCFs. In summary, available endovascular treatment options for dCCFs have expanded and provide effective solutions with generally favorable outcomes. While the choice of approach depends on individual patient factors and technique availability, traditional transvenous procedures have emerged as the first-line endovascular treatment. There is growing, favorable literature on direct transorbital and transfacial approaches; however, more studies directly comparing these general transvenous options are necessary to refine treatment strategies.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interv Neuroradiol Asunto de la revista: NEUROLOGIA / RADIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interv Neuroradiol Asunto de la revista: NEUROLOGIA / RADIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos