caa a22 4500 445298839 CHVBK 20180317142550.0 cr unu---uuuuu 170323e20100101xx s 000 0 eng 10.1007/s11940-009-0051-3 doi (NATIONALLICENCE)springer-10.1007/s11940-009-0051-3 Treatment of Carotid Cavernous Fistulas [Elektronische Daten] [Joseph Gemmete, Neeraj Chaudhary, Aditya Pandey, Sameer Ansari] Opinion statement: The treatment of a carotid cavernous fistula (CCF) depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. In most instances, endovascular treatment is preferred. High-flow direct CCFs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. They usually present with sudden development of a clinical triad: exophthalmos, bruit, and conjunctival chemosis. All direct CCFs should receive treatment, because they carry a high probability of intracranial hemorrhage or neurologic deterioration. Low-flow indirect or dural CCFs, either incidental or with minimal symptoms, are not associated with significant risk of intracranial hemorrhage. The accepted practice is to treat ocular symptoms conservatively with medical management or manual carotid compression. If the patient cannot tolerate the symptoms, or if signs of ocular morbidity occur, endovascular treatment is offered. The first treatment option should be endovascular embolization with a combination of detachable balloons, coils, stents, or liquid embolic agents. The procedure can be performed from either an arterial or venous approach. Use of these materials and techniques can yield a high cure rate with minimal complications. If the patient is not amenable to embolization or if the embolization fails, then surgery (surgical ligation of the internal carotid artery or packing of the cavernous sinus) should be offered. Stereotactic radiosurgery may be an elective treatment for low-flow CCFs, but it has no role in the treatment of high-flow CCFs. Springer Science+Business Media, LLC, 2010 Gemmete Joseph Division of Interventional Neuroradiology, Department of Radiology, University of Michigan, UH B1 D328, 1500 East Medical Center Drive, 48109-5030, Ann Arbor, MI, USA aut Chaudhary Neeraj Division of Interventional Neuroradiology, Department of Radiology, University of Michigan, UH B1 D328, 1500 East Medical Center Drive, 48109-5030, Ann Arbor, MI, USA aut Pandey Aditya Department of Neurosurgery, University of Michigan, 3352 THC, 1500 E Medical Center Dr., 48109-5338, Ann Arbor, MI, USA aut Ansari Sameer Department of Radiology, Neurology, and Surgery, Director Neurointerventional Service, University of Chicago Hospitals, 5841 S Maryland Ave, 60637, Chicago, IL, USA aut Current Treatment Options in Neurology Current Science Inc. 12/1(2010-01-01), 43-53 1092-8480 12:1<43 2010 12 11940 https://doi.org/10.1007/s11940-009-0051-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11940-009-0051-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Gemmete Joseph Division of Interventional Neuroradiology, Department of Radiology, University of Michigan, UH B1 D328, 1500 East Medical Center Drive, 48109-5030, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Chaudhary Neeraj Division of Interventional Neuroradiology, Department of Radiology, University of Michigan, UH B1 D328, 1500 East Medical Center Drive, 48109-5030, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Pandey Aditya Department of Neurosurgery, University of Michigan, 3352 THC, 1500 E Medical Center Dr., 48109-5338, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Ansari Sameer Department of Radiology, Neurology, and Surgery, Director Neurointerventional Service, University of Chicago Hospitals, 5841 S Maryland Ave, 60637, Chicago, IL, USA aut NATIONALLICENCE 773 0- Current Treatment Options in Neurology Current Science Inc 12/1(2010-01-01), 43-53 1092-8480 12:1<43 2010 12 11940 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer