Carotid Cavernous Fistulae: Various Presentations And Treatment Approaches: Results In 25 Cases 2790-2796
Dr . Lakshmi Sudha prasanna
Resident in Radiology.
Department of Radiology and Imaging Sciences
Sri Ramachandra Medical College and Research Institute, Chennai – 600 116, India.
Ph: 91- 9940517748(R), 91- 44- 24766917 (O), Fax: 91- 44- 24767008
Aim: To discuss the clinical presentation and the efficacy of endovascular management by various methods as the treatment option for direct carotid cavernous fistulae.
Method and materials: In our study, 25 patients were included during the period from 04/02/2006 to 02/12/2008. 16 were male patients and 09 were female patients with a mean age of 37 years.25 patients presented with Type A carotid fistulae, of which 21patients had an aetiology of trauma. A majority of the patients (21) presented with proptosis, the other symptoms being redeye (19), diplopia (9), headache (13) and diminished vision (17). Pre procedural workup with CT, CTA, MR and MRA was done in all the patients. High resolution DSA was done by using Advantax LCN+ (GE Biplane system). Embolisation materials in the form of balloons were used in 15 patients and coils in 5 patients. Both balloons and coils were used in 3 patients.
Results: Complete cure in the form of total reversion was achieved in twenty one patients. Improvement with residual pathology was achieved in two patients in whom there was complete clinical cure, but the angiogram demonstrated small residual fistula. The procedure was abandoned because of technical reasons in one patient. Spontaneous closure of the fistula occurred in one patient. Complications in the form of inadvertent balloon detachment occurred in two patients. Thus, complete cure was seen in 84% of our patients which is in par with the worldwide literature of 84-87% success rate.
Conclusion: Endovascular therapy is the treatment of choice for Direct carotid cavernous fistulae.