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A carotid cavernous fistula (CCF) is a disruption in the carotid arteries within the cavernous sinus. The pooling of blood in the sinus causes a myriad of neurological deficits. When correctly diagnosed, this condition can be easily managed through surgical intervention.

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Introduction And Importance: A carotid-cavernous sinus fistula is an abnormal connection between the internal or external carotid artery and the venous system of the cavernous sinus. It represents a rare entity, and it is often misdiagnosed due to its overlapping symptoms with other conditions such as cavernous sinus thrombosis or orbital inflammation. Cerebral angiography continues to be the gold standard for diagnosis and surgical planning in patients with CCF, and the endovascular trans-venous approach still represents the primary line of treatment.

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Article Synopsis
  • Endovascular embolization, particularly using Menox, is shown to be a safe and effective treatment for cranial dural arteriovenous fistulas (DAVFs) in a study involving 19 patients over a two-year period.
  • Out of the patients treated, 68.4% achieved complete occlusion of their fistulas, with the highest success rates observed in certain anatomical locations.
  • Adverse events were rare, with only one intra-procedural issue noted, highlighting the overall safety of using Menox in these procedures.
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Article Synopsis
  • Dural carotid-cavernous fistulas (dCCFs) are abnormal connections between arteries and veins in the cavernous sinus, typically treated using endovascular methods; this study reviews clinical characteristics and treatment outcomes based on these methods.
  • A systematic review analyzed 52 studies involving 736 patients and compared four main endovascular techniques: transarterial, transfemoral-transvenous, transorbital, and direct transfacial access, revealing varied occlusion rates and complications.
  • The findings indicate that while transvenous techniques generally have better occlusion rates and fewer complications, there are effective alternatives based on patient-specific factors and treatment availability, highlighting advancements in endovascular options for dCCFs.
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Background: Endovascular embolization of carotid-cavernous sinus dural arteriovenous fistulas (CCFs) is most commonly performed via a transfemoral-transvenous approach. Surgical cut-down of the superior ophthalmic vein is an alternative, well-described route. When these prove inaccessible, a transorbital approach can be used to reach the fistula.

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