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

Abstract

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.