Venous drainage patterns in carotid cavernous fistulas

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Date
2017-01-01Author
ARALAŞMAK, AYŞEKARAALİ, KAMİL
ÖZDEMİR, HÜSEYİN
ALKAN, ALPAY
TOPRAK, HÜSEYİN
SİNDEL, TİMUR
ŞENOL, UTKU
ÇEVİKOL, CAN
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Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect
the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography
(DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of
13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage
patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques.
Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type.
Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were
the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing
direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses.
Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs
and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.
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