Closure of carotid-cavernous fistulas by intracavernous surgical insertion of biological materials

  • F. Isamat


Carotid-cavernous fistulas (CCFs) have traditionally been classified into traumatic and spontaneous. Nonetheless the most important implications of a CCF are those related to the anatomical and hemodynamic characteristics of the fistula. Parkinson [21,22,23] and, particularly, Barrow et al. [1, 2], have proposed a classification based on these aspects. CCFs belonging to Parkinson’s type I or Barrow’s type A are direct communications between the internal carotid artery (ICA) and the venous plexus of the cavernous sinus. They are high-pressure high-flow shunts due to a tear in the wall of the intracavernous part of the ICA and are usually of traumatic origin. The clinical manifestations are generally abrupt and severe. They may consist in exophthalmus, chemosis, extraocular palsies, headaches, trigeminal dysesthesias, visual loss and the hearing of a disturbing bruit synchronous with the pulse. Massive epistaxis, although uncommon, can be fatal.


Internal Carotid Artery Fibrin Sealant Internal Carotid Artery Occlusion Left Internal Carotid Artery Detachable Balloon 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Barrow DL, Fleisher AS, Hoffman JC (1982) Complications of detachable balloon catheter technique in the treatment of traumatic intracranial arteriovenous fistulas. J Neurosurg 56: 396–403PubMedCrossRefGoogle Scholar
  2. 2.
    Barrow DL, Spector RH, Braun IF et al (1985) Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 62: 248–256PubMedCrossRefGoogle Scholar
  3. 3.
    Benati A, Maschio A, Perini S et al (1980) Treatment of posttraumatic carotid- cavernous fistula using a detachable balloon catheter. J Neurosurg 53: 784–786PubMedCrossRefGoogle Scholar
  4. 4.
    Black P, Umatsu S, Perovic M et al (1973) Carotid-cavernous fistula: a controlled embolus technique for occlusion of fistula with preservation of carotid flow. Technical note. J Neurosurg 38: 113–118PubMedCrossRefGoogle Scholar
  5. 5.
    Dandy WE, Follis RH Jr (1941) On the pathology of carotid-cavernous aneurysms (pulsating exophthalmos). Am J Opthalmol 24: 356–385Google Scholar
  6. 6.
    Day AL, Rhoton AL Jr (1982) Aneurysms and arterio-venous fistulae in the intracavernous carotid artery and its branches. In: Youmans JR (ed) Neurological surgery, 2nd edn. Saunders, Philadelphia, pp 1764–1785Google Scholar
  7. 7.
    Debrun G, Lacour P, Caron JP et al (1978) Detachable balloon and calibrated techniques in the treatment of cerebral vascular lesions. J Neurosurg 49: 635–349PubMedCrossRefGoogle Scholar
  8. 8.
    Debrun G, Lacour P, Vinuela F et al (1981) Treatment of 54 traumatic carotid- cavernous fistulas. J Neurosurg 55: 678–692PubMedCrossRefGoogle Scholar
  9. 9.
    Echols DH, Jackson JD (1959) Carotid-cavernous fistula: a perplexing surgical problem. J Neurosurg 16: 619–627PubMedCrossRefGoogle Scholar
  10. 10.
    Hamby WB (1964) Carotid-cavernous fistula: report of 32 surgically treated cases and suggestions for definitive operation. J Neurosurg 21: 859–866PubMedCrossRefGoogle Scholar
  11. 11.
    Handa J, Handa H (1976) Severe epistaxis caused by traumatic aneurysm of cavernous carotid artery. Surg Neurol 5: 241–243PubMedGoogle Scholar
  12. 12.
    Hosobuchi Y (1975) Electrothrombosis of carotid-cavernous fistula. J Neurosurg 42: 76–85PubMedCrossRefGoogle Scholar
  13. 13.
    Isamat F, Salleras V, Miranda AM (1970) Artificial embolization of carotid- cavernous fistula with postoperative patency of internal carotid artery. J Neurol Neurosurg Psychiatry 33: 674–678PubMedCrossRefGoogle Scholar
  14. 14.
    Isamat F, Ferrer E, Twose J (1986) Direct intracavernous obliteration of high- flow carotid cavernous fistulas. J Neurosurg 65: 770–775PubMedCrossRefGoogle Scholar
  15. 15.
    Johnston 1(1979) Direct surgical treatment of bilateral intracavernous internal carotid artery aneurysms. Case report. J Neurosurg 51: 98–102Google Scholar
  16. 16.
    Kerber CW, Bank WO, Cromwell LD (1979) Cyanoacrylate occlusion of carotid-cavernous fistula with preservation of carotid artery flow. Neurosurgery 4: 210–215PubMedCrossRefGoogle Scholar
  17. 17.
    Lapras C, Pierluca P, Taboada F (1983) Direct open surgical approach of the cavernous sinus for the treatment of carotid-cavernous fistula, with preservation of the internal carotid artery, without hypothermia and circulatory arrest. Experience of two cases. Presented at the 7th Eur Congr Neurosurg in Brussels, Aug. 28–Sept. 3, 1983Google Scholar
  18. 18.
    Moringlane JR, Ostertag CB (1985) L’occlusion des anévrismes expérimentaux. Presented at the Annu Meet Soc Neurochir Française in Paris, Dec. 9–12, 1985Google Scholar
  19. 19.
    Morley TP (1976) Appraisal of various forms of management in 41 cases of carotid-cavernous fistulas. In: Morley TP (ed) Current controversies in neurosurgery. Saunders, Philadelphia, pp 223–236Google Scholar
  20. 20.
    Mullan S (1979) Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50: 131–144PubMedCrossRefGoogle Scholar
  21. 21.
    Parkinson D (1965) A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 23: 474–483PubMedCrossRefGoogle Scholar
  22. 22.
    Parkinson D (1967) Transcavernous repair of carotid cavernous fistula. Case report. J Neurosurg 26: 420–424PubMedCrossRefGoogle Scholar
  23. 23.
    Parkinson D (1973) Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg 38: 99–106PubMedCrossRefGoogle Scholar
  24. 24.
    Peeters FLM, van der Werf AJM (1980) Detachable balloon technique in the treatment of direct carotid-cavernous fistulas. Surg Neurol 14: 11–19PubMedGoogle Scholar
  25. 25.
    Prolo DJ, Burres KP, Hanbery JW (1977) Balloon occlusion of carotid cavernous fistula: introduction of a new catheter. Surg Neurol 7: 209–214PubMedGoogle Scholar
  26. 26.
    Samson D, Ditmore QM, Bayer CW Jr (1981) Intravascular use of isobotyl-2- cyanocrylate: 2. Treatment of carotid-cavernous fistulas. Neurosurgery 8: 52–55PubMedCrossRefGoogle Scholar
  27. 27.
    Sbeih I A, O’Laoire SA (1984) Traumatic carotid-cavernous fistula due to transection of the intracavernous carotid artery. Case report. J Neurosurg 60: 1080–1084PubMedCrossRefGoogle Scholar
  28. 28.
    Serbinenko FA (1974) Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41: 125–145PubMedCrossRefGoogle Scholar
  29. 29.
    Vinuela F, Fox AJ, Debrun G etal (1984) Spontaneous carotid-cavernous fistulas: clinical, radiological and therapeutic considerations. Experience with 20 cases. J Neurosurg 60: 976–984PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1987

Authors and Affiliations

  • F. Isamat
    • 1
  1. 1.Service of Neurosurgery, Hospital de Bellvitge Princeps d’EspanaUniversity of BarcelonaBarcelonaSpain

Personalised recommendations