Published online Apr 28, 2013. doi: 10.4329/wjr.v5.i4.143
Revised: January 30, 2013
Accepted: February 5, 2013
Published online: April 28, 2013
Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.
Core tip: Carotid cavernous sinus fistulas (CCFs) are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical presentation of CCFs, which is a direct consequence of elevation in intracavernous pressure and revised flow patterns, mostly comprises of ocular findings. Recent advances in endovascular techniques have resulted in several therapeutic modalities becoming available and the endovascular approach has evolved as the primary treatment option for the management of CCFs. This review provides detailed information about classification, etiology, pathophysiology, clinical presentation, diagnostic modalities, differential diagnosis, indications for emergency treatment, post-treatment follow-up and treatment modalities with emphasis on the endovascular approach in CCFs.