Introduction To describe the clinical features, endovascular treatment and outcome in 48 patients with indirect carotid cavernous fistulas (CCFs) over a 10-year period.
Materials and methods A retrospective evaluation of our clinical records over the last 10 years for patients who underwent examination and treatment for indirect CCF was performed. Patients were reviewed by ophthalmologists and neuroradiologists before and after the treatment. Patients were initially evaluated by fundoscopy and cross-sectional imaging. The definitive diagnosis, planning and risk stratification was done on a detailed digital subtratcion angiography study. Out of a total of 48 patients 6 were treated by manual compression, 1 patient was lost to follow-up and the remaining 41 patients (81.42%) were offered endovascular treatment. The average age of patients was 45.5 years (Range – 10 to 70 years) and all the patients were followed up for an average period of 24 months. Angiographic follow-up was performed in 35 (85.4%) patients at 6 months. Clinical and Angiographic cure with long-term clinical outcome were obtained by modified Rankin scale (mRS) and Barthel index (BI).
Results At a mean follow-up of 24 months, 38 patients (92.7%) were angiographically cured with residual filling in only 3 (7.3%) patients. Of these 2 patients continued to be clinically symptomatic. At the last follow-up, 94% patients showed good recovery (mRS, 1–2; BI 90–100), two (4%) had moderate disability (mRS, 3; BI, 50–60), and one (2%) (mRS, 4; BI, 40–50) were severely disabled. Procedure-related permanent morbidity was 2%. There was no procedure related mortality. They were treated chiefly by transvenous coiling in 25 patients (60.9%). The rest were treated by transarterial embolization in 8 patients (19.5%) or a combination in 8 patients (19.5%). Of the total 48 patients, 6 were successfully managed by manual compression alone due to their extremely slow flow nature or technical complexity. Procedure related complications were seen in a total of 13 patients (31.7%), with one hemiplegia and 6 patients (14.6%) with transient worsening of ophthalmological symptoms. The rest suffered from non-procedure related problems like hyponatremia, infections etc.
Conclusion Endovascular treatment of indirect carotid cavernous fistulas is associated with favorable outcomes and low rate of procedural morbidity. Endovascular techniques are associated with good angiographic and clinical results.
Disclosures P. Mondel: None. R. Saraf: None. U. Limaye: None.
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