Abstract：
OBJECTIVE: Spontaneous direct carotid-cavernous fistula (CCF) are usually caused by a ruptured carotid cavernous aneurysm. We studied treatment of spontaneous direct CCFs in a single-center cohort of a high-volume tertiary referral center, reporting anatomical details, technical approaches of treatment, and outcomes.
METHODS: Adult patients with a spontaneous direct CCF treated between 2010-2022 with follow-up MRI and/or DSA imaging available were retrospectively analyzed. We studied age, sex, clinical presentation, angiographic findings, treatment techniques, outcomes, and complications.
RESULTS: Out of 80 patients with CCFs, twelve patients were treated for a non-traumatic direct CCF (15%) in 13 sessions. Median age was 65 years. Two patients had an underlying connective tissue disorder. In 10 cases, the direct CCF was caused by a ruptured cavernous carotid aneurysm. The direct CCFs were treated by endovascular transarterial embolization (10 cases), transvenous embolization (1 case), or surgery (1 case). Selective closure of the shunt was possible in 10 patients. Two patients were treated with parent vessel occlusion (PVO; one endovascular; one surgical, with bypass). Complications occurred in 2 / 12 patients (17%), with permanent morbidity in two patients (17%): trigeminal neuralgia after PVO and new infarct after surgical PVO and bypass. Selective closure of CCF resulted in no morbidity. There was no mortality in our series.
CONCLUSIONS: Spontaneous direct CCFs are caused by rupture of a cavernous carotid aneurysm in most cases. Selective closure of the shunt, usually feasible transarterially with coils, achieves good results. Reconstructive endovascular techniques are preferred to minimize treatment related neurological complications.
METHODS: Adult patients with a spontaneous direct CCF treated between 2010-2022 with follow-up MRI and/or DSA imaging available were retrospectively analyzed. We studied age, sex, clinical presentation, angiographic findings, treatment techniques, outcomes, and complications.
RESULTS: Out of 80 patients with CCFs, twelve patients were treated for a non-traumatic direct CCF (15%) in 13 sessions. Median age was 65 years. Two patients had an underlying connective tissue disorder. In 10 cases, the direct CCF was caused by a ruptured cavernous carotid aneurysm. The direct CCFs were treated by endovascular transarterial embolization (10 cases), transvenous embolization (1 case), or surgery (1 case). Selective closure of the shunt was possible in 10 patients. Two patients were treated with parent vessel occlusion (PVO; one endovascular; one surgical, with bypass). Complications occurred in 2 / 12 patients (17%), with permanent morbidity in two patients (17%): trigeminal neuralgia after PVO and new infarct after surgical PVO and bypass. Selective closure of CCF resulted in no morbidity. There was no mortality in our series.
CONCLUSIONS: Spontaneous direct CCFs are caused by rupture of a cavernous carotid aneurysm in most cases. Selective closure of the shunt, usually feasible transarterially with coils, achieves good results. Reconstructive endovascular techniques are preferred to minimize treatment related neurological complications.
摘要：
目的：自发性直接颈动脉海绵窦瘘（CCF）通常由破裂的颈动脉海绵状动脉瘤引起。我们在高容量三级转诊中心的单中心队列中研究了自发性直接CCF的治疗。报告解剖细节，治疗的技术方法，和结果。
方法：回顾性分析2010-2022年间接受MRI和/或DSA成像随访的自发性直接CCF成人患者。我们研究了年龄，性别,临床表现,血管造影结果,治疗技术,结果，和并发症。
结果：在80例CCF患者中，12例患者在13个疗程中接受了非创伤性直接CCF治疗(15%).中位年龄为65岁。两名患者患有潜在的结缔组织疾病。在10个案例中，直接CCF是由破裂的海绵样颈动脉动脉瘤引起的.直接CCF经血管内动脉栓塞治疗（10例），经静脉栓塞（1例），或手术（1例）。10例患者可以选择性关闭分流。两名患者接受了母体血管闭塞治疗（PVO；一名血管内；一名手术，带旁路)。并发症发生在2/12患者（17％），2例（17％）患者的永久性发病率：PVO后的三叉神经痛和手术PVO和旁路手术后的新梗死。CCF的选择性闭合没有导致发病。我们的系列中没有死亡率。
结论：在大多数情况下，自发性直接CCF是由海绵样颈动脉动脉瘤破裂引起的。选择性关闭分流管,通常在动脉上使用线圈是可行的，取得了良好的效果。重建血管内技术是优选的，以最大程度地减少与治疗相关的神经系统并发症。
方法：回顾性分析2010-2022年间接受MRI和/或DSA成像随访的自发性直接CCF成人患者。我们研究了年龄，性别,临床表现,血管造影结果,治疗技术,结果，和并发症。
结果：在80例CCF患者中，12例患者在13个疗程中接受了非创伤性直接CCF治疗(15%).中位年龄为65岁。两名患者患有潜在的结缔组织疾病。在10个案例中，直接CCF是由破裂的海绵样颈动脉动脉瘤引起的.直接CCF经血管内动脉栓塞治疗（10例），经静脉栓塞（1例），或手术（1例）。10例患者可以选择性关闭分流。两名患者接受了母体血管闭塞治疗（PVO；一名血管内；一名手术，带旁路)。并发症发生在2/12患者（17％），2例（17％）患者的永久性发病率：PVO后的三叉神经痛和手术PVO和旁路手术后的新梗死。CCF的选择性闭合没有导致发病。我们的系列中没有死亡率。
结论：在大多数情况下，自发性直接CCF是由海绵样颈动脉动脉瘤破裂引起的。选择性关闭分流管,通常在动脉上使用线圈是可行的，取得了良好的效果。重建血管内技术是优选的，以最大程度地减少与治疗相关的神经系统并发症。
