Endovascular Management of Carotid Cavernous Fistulas

Abstract

The management of carotid cavernous fistulas (CCFs) depends on their physiopathology. The classification into traumatic and spontaneous CCFs is usually considered obsolete; it is, however, the first question that we ask when a patient with a CCF is referred to us. Knowing that a fistula is traumatic immediately tells us that we have a 95% chance of treating this fistula with a detachable balloon and with preservation of the carotid blood flow (CBF). Similarly, knowing that there is no history of trauma, one may conclude that a middleaged patient with a red eye and a sixth nerve palsy probably has a spontaneous fistula of the dural type, while in the case of an older patient with this presentation one must consider the possibility of a ruptured preexisting cavernous aneurysm. Therefore, the age of the patient and the presence or absence of a history of trauma are important in the classification of CCFs.