Introduction

Carotid cavernous fistulas (CCFs) are rare, usually follow head trauma or aneurysmal rupture. Recent treatment options include endovascular techniques such as flow diversion devices (FDDs).

Objective

To present our case treated with FDD application with transarterial cavernous-sinus coiling and present a systematic review on the use and effectiveness of FDDs in CCF treatment.

Materials and methods

We present our case of CCF treatment with FDD. A search was also conducted in PubMed, EMBASE and Cochrane until November 2020. Reference lists were also cross-checked.

Results

Including our case, thirty-eight patients were identified with a CCF that was treated with FDDs in sixteen studies. Twenty-two patients were females, nine were males and the rest unidentified. The mean age was 52,6 years (range 17–86, SD± 19.28). Thirty-six patients suffered from direct and two from indirect CCFs. Single FDD was used in four cases, single FDD with embolic materials in eleven cases, multiple overlapping FDDs were used in six cases and multiple overlapping FDDs with embolic materials were used in seventeen cases. Thirty-five patients (92,1%) had clinical improvement, immediate angiographic occlusion was seen in 44,7% of the cases, while long-term occlusion rate was 100% but with variable follow-up periods. One patient (2,6%) presented with a neurological deficit related to FDD deployment.

Conclusion

Targeted treatment of CCFs with single or overlapping FDDs with or without adjunct embolic agents offers a high success rate, both clinically and long-term angiographically compared to other endovascular methods alone. However, further research with multi-center prospective trials is warranted.

中文翻译：

---

用分流器治疗颈动脉海绵窦瘘。病例报告和系统评价

介绍

颈动脉海绵状瘘 (CCF) 很少见，通常发生在头部外伤或动脉瘤破裂后。最近的治疗选择包括血管内技术，例如分流装置 (FDD)。

客观的

介绍我们使用经动脉海绵窦弹簧圈栓塞 FDD 治疗的病例，并对 FDD 在 CCF 治疗中的使用和有效性进行系统评价。

材料和方法

我们介绍了我们用 FDD 治疗 CCF 的案例。还在 PubMed、EMBASE 和 Cochrane 中进行了搜索，直到 2020 年 11 月。参考列表也进行了交叉核对。

结果

包括我们的案例在内，在 16 项研究中，38 名患者被确定为 CCF，并接受了 FDDs 治疗。22名患者是女性，9名是男性，其余的身份不明。平均年龄为 52.6 岁（范围 17-86，SD±19.28）。36 名患者患有直接 CCF，2 名患者患有间接 CCF。4例使用单一FDD，11例使用单一FDD和栓塞材料，6例使用多个重叠FDD，17例使用多个重叠FDD和栓塞材料。35 名患者 (92.1%) 有临床改善，其中 44.7% 的病例出现立即血管造影闭塞，而长期闭塞率为 100%，但随访时间不定。一名患者 (2.6%) 出现与 FDD 部署相关的神经功能障碍。

结论

与单独的其他血管内方法相比，在临床和长期血管造影上，用单一或重叠的 FDD 靶向治疗 CCF 提供了很高的成功率，无论是在临床上还是在长期血管造影上。然而，有必要进行多中心前瞻性试验的进一步研究。