Endovascular Management of Delayed Vascular Lesions in the Cavernous Sinus after Transarterial Embolization of Traumatic Carotid-Cavernous Fistulas

ObjectiveTo describe the treatment of direct high flow carotid–cavernous sinus fistulas (dCCFs) with the double lumen balloon Scepter C.Materials and methods7 patients with dCCFs were identified and treated with a double lumen balloon Scepter C. 5 patients had post-traumatic dCCFs and two patients had spontaneous dCCFs due to a ruptured cavernous–carotid aneurysm. The double lumen balloon was used in characterizing the angioarchitecture of the fistula in all patients. The best treatment option was then decided based on the characteristics of the carotid wall tear. Embolization of the cavernous sinus was achieved with coils and injection of Onyx liquid embolic material in three patients and with coils alone in four patients. One patient required stent assisted coiling to reconstruct the internal carotid artery.Results7 patients with dCCFs were treated with transarterial embolization. All patients had immediate angiographic and clinical cure. The Scepter C balloon was used for balloon assisted coiling and injection of Onyx liquid embolic material. On follow-up, all patients had clinical symptom resolution.ConclusionsThe Scepter C balloon is a useful tool for the transarterial treatment of dCCFs.

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Transarterial Embolization of an Indirect Carotid- Cavernous Fistula with N-Butyl Cyanoacrylate

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v25i2.1109 ◽

2018 ◽

Vol 25 (2) ◽

pp. 150-156

Author(s):

Matías Negrotto ◽

Roberto Crosa ◽

Alejandra Jaume ◽

Fiorella Casanova

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cavernous Sinus ◽

Internal Carotid ◽

Transarterial Embolization ◽

External Carotid Artery ◽

External Carotid ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Carotid Cavernous Fistulas

Carotid-cavernous fistulas are vascular shunts that allow blood to flow from the carotid artery into the cavernous sinus. Some fistulas are characterized by a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus. Other carotid-cavernous fistulas are dural, consisting of a communication between the cavernous sinus and one or more meningeal branches of the internal carotid artery, the external carotid artery, or both. Endovascular management is the treatment modality of choice in these cases. We report the use of N-butyl cyanoacrylate in a successful transarterial embolization of a dural carotid-cavernous fistula fed by arterial branches of the internal -and mainly- external carotid arteries (Barrow type D).

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Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas

Neurosurgery ◽

10.1227/01.neu.0000372087.71176.fb ◽

2010 ◽

Vol 67 (2) ◽

pp. 467-470 ◽

Cited By ~ 6

Author(s):

Kenichi Sato ◽

Yasushi Matsumoto ◽

Ryushi Kondo ◽

Teiji Tominaga

Keyword(s):

Computed Tomography ◽

Endovascular Treatment ◽

Cavernous Sinus ◽

Cone Beam Computed Tomography ◽

Treatment Strategy ◽

Internal Carotid ◽

Transarterial Embolization ◽

Cone Beam ◽

The Right ◽

Carotid Cavernous Fistulas

Abstract BACKGROUND Detailed information about the anatomy of traumatic carotid cavernous fistula (CCF) is required for determining the appropriate treatment strategy. OBJECTIVE We report the usefulness of C-arm cone-beam computed tomography (CBCT) for visualizing traumatic CCF during endovascular treatment. CLINICAL PRESENTATION A 63-year-old woman presented with right pulsating tinnitus 1 week after a bicycle accident. Right internal carotid angiography demonstrated a right CCF but failed to visualize its precise location because the cavernous portion of the right internal carotid artery (ICA) was hidden by early filling of the cavernous sinus during both conventional digital subtraction angiography (DSA) and 3-dimensional digital angiography. TECHNIQUE C-arm CBCT, performed with a flat-panel detector mounted in a C-arm angiographic system, clearly depicted the tear in the medial wall of the C4 segment of the right ICA. Transarterial embolization with coils achieved complete occlusion of the CCF, and the patient's symptoms resolved immediately after the procedure. CONCLUSION C-arm CBCT is useful to visualize the communication between the ICA and cavernous sinus and helps to determine the treatment strategy for traumatic CCFs.

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Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas

Journal of Neurosurgery ◽

10.3171/2010.8.gks10977 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 21-27 ◽

Cited By ~ 5

Author(s):

Hyun Ho Jung ◽

Jong Hee Chang ◽

Kum Whang ◽

Jin Soo Pyen ◽

Jin Woo Chang ◽

...

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Transarterial Embolization ◽

Gamma Knife Surgery ◽

Low Flow ◽

Close Monitoring ◽

Arteriovenous Fistulas ◽

Ocular Symptoms ◽

Dural Arteriovenous Fistulas

Object The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9–59 months). Results All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4–24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12–24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period. Conclusions Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.

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Embolization of direct carotid cavernous fistulas with the novel double-balloon technique

Interventional Neuroradiology ◽

10.1177/1591019915609779 ◽

2015 ◽

Vol 22 (2) ◽

pp. 201-205 ◽

Cited By ~ 4

Author(s):

Yin Niu ◽

Lin Li ◽

Jun Tang ◽

Gang Zhu ◽

Zhi Chen

Keyword(s):

Transarterial Embolization ◽

The Novel ◽

Cerebral Vascular Disease ◽

Safety And Efficacy ◽

Double Balloon ◽

Recurrent Fistula ◽

Balloon Technique ◽

Carotid Cavernous Fistulas ◽

Prospective Database

Multiple endovascular management of direct carotid cavernous fistula (CCF) has been widely accepted as a treatment option. Embolization of the fistula with detachable balloons or thrombogenic coil-based occlusion has been the main choice to treat direct CCF, with good safety and efficacy. This study investigated the safety and efficacy of embolization of direct CCF with the novel double-balloon technique. A retrospective review of a prospective database on cerebral vascular disease was performed. We identified a total of five patients presenting with high-flow direct CCF. All patients were managed with transarterial embolization with the novel double-balloon technique. Three of the five patients were treated with two detachable balloons, and a completely occluded fistula with preservation of the internal carotid artery was achieved. Of the remaining two patients treated with more detachable balloons, one patient achieved a perfect outcome and the other one suffered from recurrent fistula due to balloon migration 3 weeks after embolization. During a follow-up period of 12–18 months, no symptoms reoccurred in any patient. Thus, the double-balloon treatment may be a promising method for CCF complete occlusion. This novel technique may bring more benefits in the following two cases: 1). A single inflated detachable balloon fails to completely occlude the CCF, which causing the next balloon can not pass into the fistula. 2). A giant CCF needs more balloons for fistula embolization.

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