Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of Surgery, Faculty of Medicine, University of Al-Ameed, Karbala, Iraq.
J Clin Neurosci. 2021 Apr;86:230-234. doi: 10.1016/j.jocn.2021.01.047. Epub 2021 Feb 11.
Direct carotid cavernous fistula (CCF) occurs between the internal carotid artery (ICA) and the cavernous sinus. Carotid cavernous fistulas (CCFs) frequently present with chemosis, pulsatile proptosis, ocular bruit, vision loss, and occasionally intracerebral hemorrhage or seizure. In this article, we share our experience in endovascular treatment of six patients having this pathology with intracranial flow diverting stents with review of literatures.
All six patients had posttraumatic direct CCF, most of their signs and symptoms were visual disturbance, chemosis, orbital bruit, headache, paralysis of extraocular muscles. They were treated with flow diversion stents with or without coils or liquid embolizing material; transvenous and transarterial routes were used. Most of them underwent multiple sessions, and their conditions were improved dramatically.
The best and most effective method is to start the procedure by coiling to convert the high-flow fistula to an aneurysmal pouch with the smallest possible size in the cavernous sinus, and then close the defect site with one or two flow diversion devices (FDDs).
直接颈动脉海绵窦瘘（CCF）发生于颈内动脉（ICA）和海绵窦之间。颈动脉海绵窦瘘（CCF）常表现为球结膜水肿、搏动性突眼、眼杂音、视力丧失，偶尔还会出现颅内出血或癫痫。在本文中，我们分享了使用颅内血流导向支架治疗 6 例此类患者的经验，并对文献进行了回顾。
所有 6 例患者均为外伤性直接 CCF，其主要症状和体征为视力障碍、球结膜水肿、眼眶杂音、头痛、眼外肌麻痹。这些患者接受了单纯或联合使用血流导向支架、弹簧圈或液体栓塞剂的治疗，采用了经静脉和经动脉入路。大多数患者接受了多次治疗，病情明显改善。
最好和最有效的方法是首先通过线圈栓塞将高流量瘘转变为海绵窦内尽可能小的囊状动脉瘤，然后使用一个或两个血流导向装置（FDD）封闭瘘口。
