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Bathini A, Qazi Z, Bendok BR. Commentary: Transcavernous Surgical Approach for the Treatment of Carotid-Cavernous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:119-120. [PMID: 37850914 DOI: 10.1227/ons.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Abhijith Bathini
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
| | - Zeeshan Qazi
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
- Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Department of Radiology, Mayo Clinic, Phoenix , Arizona , USA
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Tsuda K, Ota T, Kono M, Ihara S. Flow diverter stents for pediatric traumatic carotid cavernous fistula: a case report and literature review. Childs Nerv Syst 2022; 38:1409-1413. [PMID: 34860259 DOI: 10.1007/s00381-021-05423-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
A 10-year-old, male patient with a head injury caused by a fall presented with chemosis, exophthalmos, right orbital bruit, and intracranial venous reflux, based on which posttraumatic carotid cavernous fistula (CCF) was diagnosed. Coil embolization was semi-urgently performed for the dangerous venous drainage. After the treatment, right abducens nerve palsy newly appeared. To treat the neurological symptoms and preserve the parent artery, curative endovascular treatment using a pipeline embolization device (PED) with coil embolization was performed after starting dual antiplatelet therapy (DAPT). The CCF and abducens nerve palsy finally resolved, and the internal carotid artery (ICA) was remodeled. Use of the PED with adjunctive coil embolization was effective and safe in the present case of pediatric traumatic direct CCF.
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Affiliation(s)
- Kyoji Tsuda
- Department of Neurosurgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Maya Kono
- Department of Neurosurgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Satoshi Ihara
- Department of Neurosurgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
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Stamatopoulos T, Anagnostou E, Plakas S, Papachristou K, Lagos P, Samelis A, Derakhshani S, Mitsos A. Treatment of carotid cavernous sinus fistulas with flow diverters. A case report and systematic review. Interv Neuroradiol 2022; 28:70-83. [PMID: 33966468 PMCID: PMC8905080 DOI: 10.1177/15910199211014701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Carotid cavernous fistulas (CCFs) are rare, usually follow head trauma or aneurysmal rupture. Recent treatment options include endovascular techniques such as flow diversion devices (FDDs). OBJECTIVE To present our case treated with FDD application with transarterial cavernous-sinus coiling and present a systematic review on the use and effectiveness of FDDs in CCF treatment. MATERIALS AND METHODS We present our case of CCF treatment with FDD. A search was also conducted in PubMed, EMBASE and Cochrane until November 2020. Reference lists were also cross-checked. RESULTS Including our case, thirty-eight patients were identified with a CCF that was treated with FDDs in sixteen studies. Twenty-two patients were females, nine were males and the rest unidentified. The mean age was 52,6 years (range 17-86, SD± 19.28). Thirty-six patients suffered from direct and two from indirect CCFs. Single FDD was used in four cases, single FDD with embolic materials in eleven cases, multiple overlapping FDDs were used in six cases and multiple overlapping FDDs with embolic materials were used in seventeen cases. Thirty-five patients (92,1%) had clinical improvement, immediate angiographic occlusion was seen in 44,7% of the cases, while long-term occlusion rate was 100% but with variable follow-up periods. One patient (2,6%) presented with a neurological deficit related to FDD deployment. CONCLUSION Targeted treatment of CCFs with single or overlapping FDDs with or without adjunct embolic agents offers a high success rate, both clinically and long-term angiographically compared to other endovascular methods alone. However, further research with multi-center prospective trials is warranted.
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Affiliation(s)
- Theodosios Stamatopoulos
- Department of Neurosurgery, 401 General Military Hospital of Athens, Athens, Greece,Center of Orthopaedics and Regenerative Medicine (C.O.R.E.), Center for Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece,Theodosios Stamatopoulos, Department of Neurosurgery, 401 General Military Hospital of Athens, Panagioti Kanellopoulou and Mesogeion Ave, Athens 11525, Greece.
| | - Evangelos Anagnostou
- Department of Neurosurgery, 401 General Military Hospital of Athens, Athens, Greece
| | - Sotirios Plakas
- Department of Neurosurgery, 401 General Military Hospital of Athens, Athens, Greece
| | | | - Panagiotis Lagos
- Department of Neurosurgery, 401 General Military Hospital of Athens, Athens, Greece
| | - Apostolos Samelis
- Department of Neurosurgery, 401 General Military Hospital of Athens, Athens, Greece
| | - Shahram Derakhshani
- Department of Interventional and Therapeutic Neuroradiology, Queen's University Hospital, Essex Center for Neurological Sciences, London, UK
| | - Aristotelis Mitsos
- Department of Neurosurgery, 401 General Military Hospital of Athens, Athens, Greece
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Giorgianni A, Agosti E, Terrana A, Pozzi F, Sileo G, Nativo L, Balbi S, Motta A, Castelnuovo P, Locatelli D, Turri-Zanoni M. Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience. Acta Neurochir (Wien) 2021; 163:2055-2061. [PMID: 32808087 PMCID: PMC8195932 DOI: 10.1007/s00701-020-04517-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/30/2020] [Indexed: 11/05/2022]
Abstract
Background and objective To describe our single-center experience in the treatment of cavernous internal carotid artery (ICA) acute bleeding with flow diverter stent (FDS), as a single endovascular procedure or combined with an endoscopic endonasal approach. Methods We analyze a case series of 5 patients with cavernous ICA acute bleeding, i.e., 3 iatrogenic, 1 post-traumatic, and 1 erosive neoplastic. After an immediate nasal packing to temporarily bleeding control, patients underwent digital subtraction angiography (DSA) to identify the site of the ICA injury. A concomitant balloon occlusion test (BOT) was performed, to exclude post-occlusive ischemic neurological damage. An FDS was placed with parallel intravenous infusion of abciximab in 3 cases and tirofiban in 2 cases. In two patients, an innovative “sandwich technique” combining the endovascular reconstruction with an extracranial intrasphenoidal cavernous ICA resurfacing with autologous flaps or grafts by endoscopic endonasal approach was performed. Results No patient had periprocedural ischemic-hemorrhagic complications. All patients had a regular clinical evolution, without general complications or new onset of focal neurological deficits. No further bleeding occurred in 3 patients, while 2 cases experienced a mild rebleeding in a period ranging from 5 to 15 days after the endovascular procedure. In these two cases, we proceeded with an endoscopic endonasal procedure to resurface the exposed ICA wall in the sphenoid sinus. Conclusions Although the treatment of choice for cavernous ICA acute bleeding remains the occlusion of the injured vessel, in cases of poor hemodynamic compensation at the BTO, the endovascular FDS emergency placement can be effective. A combined endoscopic endonasal technique to support the extracranial side of the vessel using autologous flaps or grafts can be performed to prevent the risk of rebleeding.
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Affiliation(s)
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy.
| | - Alberto Terrana
- Department of Neuroradiology, ASST Sette Laghi, Varese, Italy
| | - Fabio Pozzi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luca Nativo
- Department of Neuroradiology, ASST Sette Laghi, Varese, Italy
| | - Sergio Balbi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy
| | - Alessandro Motta
- Department of Anesthesiology e Resuscitation, ASST Sette Laghi, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Department of Anesthesiology e Resuscitation, ASST Sette Laghi, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Ghorbani M, Lafta G, Rahbarian F, Mortazavi A. Treatment of post-traumatic direct carotid-cavernous fistulas using flow diverting stents: Is it alone satisfactory? J Clin Neurosci 2021; 86:230-234. [PMID: 33775333 DOI: 10.1016/j.jocn.2021.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Direct carotid cavernous fistula (CCF) occurs between the internal carotid artery (ICA) and the cavernous sinus. Carotid cavernous fistulas (CCFs) frequently present with chemosis, pulsatile proptosis, ocular bruit, vision loss, and occasionally intracerebral hemorrhage or seizure. In this article, we share our experience in endovascular treatment of six patients having this pathology with intracranial flow diverting stents with review of literatures. CASE DESCRIPTION All six patients had posttraumatic direct CCF, most of their signs and symptoms were visual disturbance, chemosis, orbital bruit, headache, paralysis of extraocular muscles. They were treated with flow diversion stents with or without coils or liquid embolizing material; transvenous and transarterial routes were used. Most of them underwent multiple sessions, and their conditions were improved dramatically. CONCLUSION The best and most effective method is to start the procedure by coiling to convert the high-flow fistula to an aneurysmal pouch with the smallest possible size in the cavernous sinus, and then close the defect site with one or two flow diversion devices (FDDs).
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ghazwan Lafta
- Department of Surgery, Faculty of Medicine, University of Al-Ameed, Karbala, Iraq
| | - Farhad Rahbarian
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Sumdani H, Aguilar-Salinas P, Avila MJ, El-Ghanem M, Dumont TM. Carotid Cavernous Fistula Treatment via Flow Diversion: A Systematic Review of the Literature. World Neurosurg 2021; 149:e369-e377. [PMID: 33578023 DOI: 10.1016/j.wneu.2021.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Carotid cavernous fistulas (CCFs) are pathologic connections between the carotid arteries and the cavernous sinus and have been classically treated with endovascular coil embolization, although flow diverters have been used for treatment successfully multiple times. The aim of this study is to systematically review the literature for efficacy of flow diverters in treating CCFs. METHODS A systematic review was conducted using the PRISMA guidelines. PubMed, PubMed Central, Cochrane Library, and Embase databases were searched. Combinations and variations of "carotid cavernous fistula," "flow diversion," "pipeline embolization device," "Surpass," "Silk," "p64," "FRED," and "flow redirection endoluminal device" in both AND and OR configurations were used to gather relevant articles. Citations of included articles from the systematic review were also screened for possible inclusion as a part of manual review. Included studies were full-text publications written in English that had patients with diagnosed CCFs and treatment with flow diversion. RESULTS Eighteen full-text publications were relevant to this systematic review. A total of 41 patients underwent flow-diverting therapy alone or in conjunction with coil embolization, liquid embolization, and/or stenting for treatment of a diagnosed CCF. Twenty-nine patients (70.7%) needed 1 procedure alone, 11 patients (26.8%) required a second procedure, and 1 patient (2.4%) required a third procedure. Six patients (14.6%) had lasting symptoms despite intervention; however, all 41 patients had clinical improvement compared with initial presentation. Flow diversion was a useful solitary treatment or adjunctive treatment in all patients. CONCLUSIONS Flow diversion is a useful adjunct in combination with coil embolization for the treatment of CCFs but long-term outcomes remain to be seen.
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Affiliation(s)
- Hasan Sumdani
- Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | | | - Mauricio J Avila
- Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Mohammad El-Ghanem
- Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA; Department of Neurology, University of Arizona, Tucson, Arizona, USA
| | - Travis M Dumont
- Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA.
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