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E-174 Endovascular approaches for the treatment of dural carotid-cavernous fistulas: a systematic review
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  1. E Dowlati1,
  2. E Harake1,
  3. E Nieblas-Bedolla1,
  4. Z Wilseck2,
  5. N Chaudhary2,
  6. R Armonda3,
  7. A Pandey1
  1. 1Neurosurgery, University of Michigan, Ann Arbor, MI
  2. 2Radiology, University of Michigan, Ann Arbor, MI
  3. 3Neurosurgery, MedStar Georgetown University Hospital, Washington, DC

Abstract

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 aimed to investigate the clinical characteristics of patients with dCCFs based on 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 48 studies were included examining four primary endovascular approaches for treating dCCFs: transarterial, transfemoral-transvenous (transpetrosal or other), transorbital(percutaneous or via cut-down), and direct transfacial access. Overall data was collected from 694 patients with 756 dCCFs. Transarterial approaches exhibit lower dCCF occlusion rates (75.5%) compared to transvenous techniques via the inferior petrosal sinus (89.0%). The transorbital approach via direct puncture or surgical cut-down 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 promise with up to 100% occlusion rates and minimal complications. 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.

Disclosures E. Dowlati: None. E. Harake: None. E. Nieblas-Bedolla: None. Z. Wilseck: None. N. Chaudhary: None. R. Armonda: None. A. Pandey: None.

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