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World J Radiol. Apr 28, 2013; 5(4): 143-155
Published online Apr 28, 2013. doi: 10.4329/wjr.v5.i4.143
Endovascular treatment of carotid cavernous sinus fistula: A systematic review
Bora Korkmazer, Burak Kocak, Ercan Tureci, Civan Islak, Naci Kocer, Osman Kizilkilic
Bora Korkmazer, Burak Kocak, Civan Islak, Naci Kocer, Osman Kizilkilic, Division of Neuroradiology, Department of Radiology, Cerrahpasa School of Medicine, Istanbul University, 34098 Istanbul, Turkey
Ercan Tureci, Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University, 34098 Istanbul, Turkey
Author contributions: Kizilkilic O and Korkmazer B designed the study; Korkmazer B and Kocak B conducted literature research; Korkmazer B wrote the paper; Korkmazer B, Islak C, Kizilkilic O, Kocer N, Kocak B, and Tureci E edited and revised the paper.
Correspondence to: Osman Kizilkilic, MD, Associated Professor, Division of Neuroradiology, Department of Radiology, Cerrahpasa School of Medicine, Istanbul University, Osman Gazi Mh., Paşa Sk, 34098 Istanbul, Turkey. osmank@istanbul.edu.tr
Telephone: +90-212-4143000 Fax: +90-212-4143021
Received: November 30, 2012
Revised: January 30, 2013
Accepted: February 5, 2013
Published online: April 28, 2013
Processing time: 158 Days and 3 Hours
Abstract

Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.

Keywords: Cavernous sinus; Carotid cavernous sinus fistula; Endovascular treatment

Core tip: Carotid cavernous sinus fistulas (CCFs) are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical presentation of CCFs, which is a direct consequence of elevation in intracavernous pressure and revised flow patterns, mostly comprises of ocular findings. Recent advances in endovascular techniques have resulted in several therapeutic modalities becoming available and the endovascular approach has evolved as the primary treatment option for the management of CCFs. This review provides detailed information about classification, etiology, pathophysiology, clinical presentation, diagnostic modalities, differential diagnosis, indications for emergency treatment, post-treatment follow-up and treatment modalities with emphasis on the endovascular approach in CCFs.