%0 Journal Article
%T Carotid Cavernous Fistula, Experience in Pakistani Population
%A Shahzad Bhatti
%A Umair Rashid
%J Iranian Journal of Radiology
%D 2012
%I Tehran University of Medical Sciences
%X Background/Objective: Carotid cavernous fistula is an abnormal communication between the carotid system and the cavernous sinus. They can be direct due to the communication between the internal carotid artery (ICA) and the cavernous sinus (CS) mostly post traumatic. Indirect due to the communication between branches of ICA or external carotid artery (ECA) with CS which mostly occur spontaneously in post menopausal omen.Diagnosis is made by CT or MRI. The most definitive diagnosis is by digital subtraction angiography (DSA) which helps to diagnose, but also to treat the fistula by embolization. We will discuss our experience in the diagnosis and treatment of carotid cavernous fistula (CCF) by embolization.Materials and Methods: Out of 50 patients with CCF, 40 were treated with detachable balloons mainly through the transarterial route from March 2007 to March 2011. Diagnosis was confirmed by diagnostic four-vessel angiography. Goldball balloons of variable sizes were used for embolization. 3D reconstruction was performed before embolization and most of them were checked by dyna CT immediately after embolization.Results: Complete angiographic obliteration in 35 patients immediately after embolization. Marked improvement in three cases and failure in two cases due to abnormal tortuosity of the vessels. Residual shunting in seven patients improved in one month to 1 year. Headache and vomiting were most common after the procedure. One case had ischemia of distal branches of M2 segment of the right middle cerebral artery (MCA), which improved later. No mortality. No recurrence during follow upConclusion: Transarterial embolization is the treatment of choice for CCF particularly if post traumatic. It is an efficient, safe and economical method.
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%U http://journals.tums.ac.ir/PdfMed.aspx?pdf_med=/upload_files/pdf/21127.pdf&manuscript_id=21127