[Direct carotid-cavernous fistulas: clinical presentation, angioarchitectonics and endovascular management].

Abstract MATERIALS AND METHODS: Since 1992 till 2007 233 male and 125 female patients (total--358) with direct carotid-cavernous fistulas (CCF) were operated. Mean age was 36.3 years. 88.5% of all cases were traumatic, 10.6% spontaneous, 0.3% congenital and 0.6% iatrogenic. CCF occlusion was performed via arterial, venous and combined endovascular approaches using balloon-catheters, coils and stents. Reconstructive surgeries were made in 78.7% of patients, deconstructive--in 21, Share of reconstructive operations has grown by 18.7% compared to the previous decade and succeeded 89.5% during recent 5 years due to development of modern endovascular techniques (balloon- and stent-assistance, venous approach). Recurrent fistulas after transarterial balloon occlusion was encountered in 10.3% of patients and were caused by decrease of volume or migration of balloon, which required additional intervention. Complete occlusion was achieved in 92.3% of cases, subtotal in 3.6%, partial in 4.1%. Two groups of patients treated with detachable balloon-catheters designed by prof. F.A. Serbinenko (DBC) and valve balloon-catheters (VBC) were analyzed. In the VBC group recurrent CCF were observed 1.5 time higher, but incomplete occlusion of the fistula and occlusion of ICA was observed 2 and 2.4 times, respectively, rarer than in DBC group. Early clinical outcomes were evaluated within 1-4 weeks; by date of discharge full recovery was achieved in 3.6% of cases, improvement in 84.4%, no changes were revealed in 6.7%. 4.5% of patients produced persistent neurological deficit presented by deterioration in oculomotor function (3.1%) and consequences of ischemic processes in cerebral hemispheres (1.4%). Postoperative mortality was 0.84%. Consequences were commonly caused by formation of pseudoaneurysms of ICA in cavernous sinus and sphenoid sinus (10.3%). Infectious complications developed in 3 patients (0.84%). Transarterial endovascular occlusion is treatment of choice in management of CCF. Modern endovascular techniques allowed significant advances in effectiveness of endovascular treatment of CCF. The problem of development and treatment of pseudoaneurysms after balloon occlusion of CCF claims for separate detailed analysis.