Endovascular management of dural fistulas into the cavernous sinus

Background: Dural fistula to the cavernous sinus (DFCS) is an infrequent pathology that consists in the anomalous communication between the meningeal branches of the internal carotid artery (ICA) and/or the external carotid artery (ECA) and the cavernous sinus. Aim: To perform a systematic review t...

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Main Authors: Luis Rafael Moscote-Salazar, Marco Zenteno, Jorge A. Santos-Franco, Nancy Carolina Duarte-Valdivieso, Hernando Raphael Alvis-Miranda, Angel Lee
Format: Article
Language:English
Published: London Academic Publishing 2014-06-01
Series:Romanian Neurosurgery
Subjects:
Online Access:https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/738
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spelling doaj-b9d72000f15e4e58bfda7f9871b58f242020-11-25T01:05:14ZengLondon Academic PublishingRomanian Neurosurgery1220-88412344-49592014-06-01212Endovascular management of dural fistulas into the cavernous sinusLuis Rafael Moscote-SalazarMarco ZentenoJorge A. Santos-FrancoNancy Carolina Duarte-ValdiviesoHernando Raphael Alvis-MirandaAngel Lee Background: Dural fistula to the cavernous sinus (DFCS) is an infrequent pathology that consists in the anomalous communication between the meningeal branches of the internal carotid artery (ICA) and/or the external carotid artery (ECA) and the cavernous sinus. Aim: To perform a systematic review to evaluate clinical and imaging findings in DFCS, and current indications for treatment. Methods: A literature search was performed in several medical databases using the keywords “intracranial dural fistula”, “carotid-cavernous fistula”, “endovascular treatment”, associated with “outcome”; resulting articles were assessed by considering factors such as: number of patients treated, type of material used, complications, and type of image technique used for diagnosis. Results: 33 articles were selected, yielding: clinical and imaging: The symptoms are basically related to the type of venous drainage of the fistula. The combination of ocular symptoms and tinnitus is highly suggestive of DFCS. Ocular symptoms are found in 80-97% of patients, while the tinnitus is present in up to 50% of cases. The imaging method for initial assessment of the DFCS is the magnetic resonance imaging. Digital subtraction angiography is the method of choice to determine adequately the precise angioarchitecture of the injury and its drainage. This data is of vital importance in future decision making. Treatment: Currently are considered as indications for the management of DFCS: 1) rapidly progressive deterioration of visual function, 2) angiographic evidence of abnormal cortical venous drainage, 3) the hypoxic consequences in retina and optic nerve, and 4) ischemic keratitis; the most suitable materials for embolization of the DFCS are CA and PAP. Conclusion: DFCS stills being an uncommon cerebrovascular condition, with good outcomes from endovascular treatment. https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/738Dural fistulacarotid-cavernous fistulasN-butil-cyanoacrylatecavernous sinus
collection DOAJ
language English
format Article
sources DOAJ
author Luis Rafael Moscote-Salazar
Marco Zenteno
Jorge A. Santos-Franco
Nancy Carolina Duarte-Valdivieso
Hernando Raphael Alvis-Miranda
Angel Lee
spellingShingle Luis Rafael Moscote-Salazar
Marco Zenteno
Jorge A. Santos-Franco
Nancy Carolina Duarte-Valdivieso
Hernando Raphael Alvis-Miranda
Angel Lee
Endovascular management of dural fistulas into the cavernous sinus
Romanian Neurosurgery
Dural fistula
carotid-cavernous fistulas
N-butil-cyanoacrylate
cavernous sinus
author_facet Luis Rafael Moscote-Salazar
Marco Zenteno
Jorge A. Santos-Franco
Nancy Carolina Duarte-Valdivieso
Hernando Raphael Alvis-Miranda
Angel Lee
author_sort Luis Rafael Moscote-Salazar
title Endovascular management of dural fistulas into the cavernous sinus
title_short Endovascular management of dural fistulas into the cavernous sinus
title_full Endovascular management of dural fistulas into the cavernous sinus
title_fullStr Endovascular management of dural fistulas into the cavernous sinus
title_full_unstemmed Endovascular management of dural fistulas into the cavernous sinus
title_sort endovascular management of dural fistulas into the cavernous sinus
publisher London Academic Publishing
series Romanian Neurosurgery
issn 1220-8841
2344-4959
publishDate 2014-06-01
description Background: Dural fistula to the cavernous sinus (DFCS) is an infrequent pathology that consists in the anomalous communication between the meningeal branches of the internal carotid artery (ICA) and/or the external carotid artery (ECA) and the cavernous sinus. Aim: To perform a systematic review to evaluate clinical and imaging findings in DFCS, and current indications for treatment. Methods: A literature search was performed in several medical databases using the keywords “intracranial dural fistula”, “carotid-cavernous fistula”, “endovascular treatment”, associated with “outcome”; resulting articles were assessed by considering factors such as: number of patients treated, type of material used, complications, and type of image technique used for diagnosis. Results: 33 articles were selected, yielding: clinical and imaging: The symptoms are basically related to the type of venous drainage of the fistula. The combination of ocular symptoms and tinnitus is highly suggestive of DFCS. Ocular symptoms are found in 80-97% of patients, while the tinnitus is present in up to 50% of cases. The imaging method for initial assessment of the DFCS is the magnetic resonance imaging. Digital subtraction angiography is the method of choice to determine adequately the precise angioarchitecture of the injury and its drainage. This data is of vital importance in future decision making. Treatment: Currently are considered as indications for the management of DFCS: 1) rapidly progressive deterioration of visual function, 2) angiographic evidence of abnormal cortical venous drainage, 3) the hypoxic consequences in retina and optic nerve, and 4) ischemic keratitis; the most suitable materials for embolization of the DFCS are CA and PAP. Conclusion: DFCS stills being an uncommon cerebrovascular condition, with good outcomes from endovascular treatment.
topic Dural fistula
carotid-cavernous fistulas
N-butil-cyanoacrylate
cavernous sinus
url https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/738
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