Dural carotid cavernous fistula: Definitive endovascular management and long-term follow-up

PURPOSE: To describe the endovascular treatment and clinical outcome in patients with indirect carotid cavernous fistulas (CCFs) over a 15-year period. To our knowledge, this is the largest series in the medical literature. DESIGN: Interventional case series. METHODS: A retrospective evaluation of 135 consecutive patients who underwent examination and treatment for indirect CCF was performed. Patients received inde, pendent evaluations by ophthalmologists, neurologists, or neuro,ophthalmologists before, during, and after endovascular treatment. Patients initially received noninvasive imaging followed by cerebral arteriography for definitive diagnosis and stratification by angiographic risk factors. Endovascular treatment was performed in 133 (98%) patients and clinical follow,up was achieved in 135 (100%) patients on an average of 56 +/- 4.3 months (range: 2 months-14 years). Angiographic follow-up was performed in 72 (54%) patients with ongoing symptoms or a history of fistula with high risk angiographic fear tures. Arteriographic cure with long,term clinical out, come is summarized by modified Rankin scale (mRS) and Barthel index (BI). RESULTS: At a mean follow-up of 56 months, 121 (90%) patients were clinically cured. At latest clinical follow-up, 131 (97%) patients showed good recovery (mRS, 1-2; BI 90-100), one (1%) had moderate disability (mRS, 3; B1, 50-60), and three (2%) (mRS, 4; BI, 40-50) were severely disabled. Procedure-related permanent morbidity was 2.3%. There was no operative mortality. CONCLUSIONS: With the observed favorable outcomes and low rate of procedural morbidity in this patient population with long-term angiographic and clinical fol, low up, endovascular therapy should be the primary treatment for patients with indirect (dural) fistulas of the cavernoussinus. (C) 2002 by Elsevier Science Inc. All rights reserved.