Endovascular Treatment in Direct Carotid Cavernous Fistula

Direct carotid cavernous fistula (CCF) is the most common types of arteriovenous fistula (AVF) in the craniofacial area and endovascular treatment is primarily indicated in managing the disease. CCFs are abnormal, direct communications between the internal carotid arteries (ICA) and the cavernous sinuses formed as a consequence of blunt head trauma1,2. They occur secondary to traumatic laceration of the internal carotid artery at the intracavernous segment or from rupture of intracavernous branches. AVFs supplied by external carotid artery and dural branches of ICA are traditionally called indirect, or dural arteriovenous fistula of the cavernous sinus and are totally different entity with different therapeutic strategy. To understand the clinical and angiographic features and to treat this lesion properly, knowledge of vascular anatomy of the skull base and clinical features of this disease are necessary. Angiographic evaluation of the lesion, therapeutic strategies, and treatment-related problems will be discussed.