Harake Edward S, Nieblas-Bedolla Edwin, Wilseck Zachary, Chaudhary Neeraj, Armonda Rocco A, Pandey Aditya S, Dowlati Ehsan
Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
Interv Neuroradiol. 2024 Aug 8:15910199241272595. doi: 10.1177/15910199241272595.
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.
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.
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.
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.
硬脑膜型颈内动脉海绵窦瘘（dCCF），也称为间接型颈内动脉海绵窦瘘，是海绵窦内动脉系统与静脉系统之间的异常连接，通常通过血管内介入治疗。我们旨在基于血管内治疗方法研究dCCF患者的临床特征，并评估血管造影和临床结果。
对文献进行系统综述。收集并评估包括患者数量、人口统计学资料、临床表现症状、瘘的病因、巴罗分类以及栓塞材料等数据。收集的结果指标包括瘘的闭塞程度、术后症状、并发症以及平均随访时间。
共纳入52项研究，这些研究探讨了治疗dCCF的四种主要血管内介入方法：经动脉、经股静脉（经岩骨或其他途径）、经眶（经皮或切开）以及直接经面入路。总体数据来自736例患有817个dCCF的患者。与经岩下窦的静脉技术（88.1%）相比，经动脉方法的dCCF闭塞率较低（75.6%）。经直接穿刺或手术切开的经眶入路为进入海绵窦提供了更直接的途径，尽管并发症更多，包括眼眶血肿风险。直接经面静脉入路虽然有限，但显示出高达100%的闭塞率且并发症极少。
我们对治疗dCCF的四种主要血管内介入方法进行了全面综述。总之，现有的dCCF血管内治疗选择已经扩大，并提供了有效的解决方案，总体预后良好。虽然治疗方法的选择取决于个体患者因素和技术可用性，但传统的静脉手术已成为血管内治疗的一线方法。关于直接经眶和经面入路的文献越来越多且前景良好；然而，需要更多直接比较这些常规静脉治疗选择的研究来完善治疗策略。
