Abstract:
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Purpose: CCF are rare, can be spontaneous or traumatic and classification is based on arterial supply: direct shunt between ICA and cavernous sinus (type A) or dural shunt from ICA (type B) or ECA branches (type C) or both (type D). Diagnosis is made by CT, MR and DSA (gold standard); we propose CDS as first choice method for diagnosis and follow-up of the pathology.
Methods and Materials: we report our experience with 15 patients with CCF (6 type A, 2 type B, 6 type C and 1 type D), from 18 to 81 years aged. All patients were symptomatic with: chemosis, pulsating exophthalmus, bruit or diplopia in type A cases; one type B had blindness. Endovascular embolization was performed in all type A cases (with occlusion of ICA in 4 cases) and in all the other dural types except in 1 type C and 1 type B case. In all cases CDS was performed for diagnosis and follow-up and we evaluated flowmetric parameters (velocities, pulsatility index-PI- and waveform morphology) on ICA and ECA branches and on internal jugular veins (IJV) and superior ophthalmic veins (SOV).
Results: Clinical symptoms related to signs of hyperflow and reduction of PI in the ICA or ECA branches and signs of arterialization in the IJV or inversion of flow in the superior ophthalmic veins (SOV) suggested a diagnosis of CCF. Based on arterial PI values related to the other flowmetric signs, one year follow-up with CDS showed complete occlusion of CCF in 8 cases (all type A, 1 type B and 1 type C), recurrency in 4 type C cases (2 definitive occlusion after new treatment), incomplete occlusion in type D case and progressive improvement by partial thrombosis of SOV in the cases not treated.
Conclusion: CDS is a non invasive, economic and repeatable method that we retain valid and of first choice for diagnosis and follow-up of CCF. Only in about 10% of SOV thrombosis together with other dural venous drainage thrombosis with reflux into pial temporal veins CDS could be non diagnostic and clinical signs of cerebral venous hypertension should suggest the diagnosis.
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Pedicelli MD, A,
Color-Doppler Sonography (CDS) in Diagnosis and Follow-up of Carotid Cavernous Fistulas (CCF). Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3103559.html
