[Carotid cavernous fistula: endovascular therapy].

Abnormal communications between the carotidal artery and the cavernous sinus are known as carotid-cavernous fistulas. We can however distinguish between these fistulas two different evolutive and etiological entities: on the one hand there are the direct types with high flux and normally related to hard traumatisms and on the other hand there are the indirect types lacking clear etiological factors, with slower flux and which correspond to dural malformations with different arterial nutrition. In the last two years in our service we have treated eight carotid-cavernous fistulas, four direct and four indirect, using endovascular techniques with differing emboligenic materials according to the nature of the fistula, flux volume and origin. Complete closure was obtained in all patients with direct fistulas and in two whose fistulas were indirect. Closure was almost (greater than 75%) complete in the remaining two cases. In all cases symptomatology prior to intervention diminished completely a few weeks later with no relapse up until now. We discuss the classification and clinico-pathological characteristics of each fistula type, the comparative usefulness of different diagnostic methods and we review therapeutic symptoms with special emphasis on neuroradiological endovascular techniques, analyzing the usefulness of each emboligenic material type. The recent development of intervention techniques in neuroradiology makes low risk correct closure of carotid-cavernous fistulas a possibility. Endovascular is accepted as the treatment of choice today.