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Diagnosis and treatment of dural carotid–cavernous fistulas: a consecutive series of 27 patients
  1. M Théaudin1,
  2. J-P Saint-Maurice2,
  3. R Chapot2,
  4. K Vahedi1,
  5. M Mazighi2,
  6. C Vignal3,
  7. G Saliou2,
  8. C Stapf1,
  9. M-G Bousser1,
  10. E Houdart2
  1. 1Service de Neurologie, Hôpital Lariboisière, Paris, France
  2. 2Service de Neuroradiologie, Hôpital Lariboisière, Paris, France
  3. 3Service d’Ophtalmologie, Hôpital Lariboisière, Paris, France
  1. Correspondence to:
 E Houdart
 Service de Neuroradiologie, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; emmanuel.houdart{at}lrb.aphp.fr

Abstract

Objectives: To report clinical characteristics, angiographical findings and results of endovascular treatment of patients presenting with dural carotid–cavernous fistulas (DCCFs).

Method: Retrospective analysis of 27 consecutive patients with DCCF referred to a specialised interventional neuroradiology department.

Results: Orbital and neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis (n = 25). The venous drainage of the fistula involved the ipsilateral superior ophthalmic vein in 24 patients, the contralateral cavernous sinus in 6 and a leptomeningeal vein in 5 patients. Thrombosis of at least one petrosal sinus was found in 23 patients. 7 patients did not receive endovascular treatment: 3 had spontaneous DCCF obliteration, and 4 had only minor clinical symptoms and no leptomeningeal venous drainage on an angiogram. 20 patients received endovascular treatment via either a transvenous (n = 16) or a transarterial approach (n = 4). Complete occlusion of the fistula was obtained in 14 of 16 (87%) patients treated by the transvenous approach and in 1 of 4 (25%) patients treated by the transarterial approach. 16 patients had early clinical improvement after endovascular treatment. One patient had a cerebral haemorrhage after transvenous embolisation of a DCCF with leptomeningeal drainage. On follow-up, all patients treated by the transarterial route remained symptomatic, whereas 10 of 14 (71%) patients cured by the transvenous route were asymptomatic.

Conclusions: Transvenous embolisation is a safe and efficient endovascular approach to treat patients with DCCF. However, this technique requires a long learning curve.

  • DCCF, dural carotid–cavernous fistulas

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Footnotes

  • Published Online First 6 October 2006

  • Competing interests: None declared.

  • Informed consent was obtained for publication of figure 1.

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