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Repository of Research and Investigative Information

Ilam University of Medical Sciences

Clinical efficacy of endovascular treatment approach in patients with carotid cavernous fistula: A systematic review and meta-analysis

Mon Feb 26 04:20:31 2024

(2023) Clinical efficacy of endovascular treatment approach in patients with carotid cavernous fistula: A systematic review and meta-analysis. World neurosurgery: X. p. 100189. ISSN 2590-1397 (Electronic) 2590-1397 (Linking)

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Official URL: https://www.ncbi.nlm.nih.gov/pubmed/37223772

Abstract

BACKGROUND AND OBJECTIVES: Carotid-cavernous fistulas (CCFs) represent a group of rare, abnormal arteriovenous communications between the carotid arterial system and the cavernous sinuses (CS). CCFs often produce ophthalmologic symptoms related to increased CS pressures and retrograde venous drainage of the eye. Although endovascular occlusion remains the preferred treatment for symptomatic or high-risk CCFs, most of the data for these lesions is limited to small, single-center series. As such, we performed a systematic review and meta-analysis evaluating endovascular occlusions of CCFs to determine any differences in clinical outcomes based on presentation, fistula type, and treatment paradigm. METHOD: A retrospective review of all studies discussing the endovascular treatment of CCFs published through March 2023 was conducted using PubMed, Scopus, Web of Science, and Embase databases. A total of 36 studies were included in the meta-analysis. Data from the selected articles were extracted and analyzed using Stata software version 14. RESULTS: 1494 patients were included. 55.08 were female and the mean age of the cohort was 48.10 years. A total number of 1516 fistulas underwent endovascular treatment, 48.05 of which were direct and 51.95 of which were indirect. 87.17 of CCFs were secondary to a known trauma while 10.18 were spontaneous. The most common presenting symptoms were 89 exophthalmos (95 CI: 78.0-100.0; I(2) = 75.7), 84 chemosis (95 CI: 79.0-88.0; I(2) = 91.6), 79 proptosis (95 CI: 72.0-86.0; I(2) = 91.8), 75.0 bruits (95 CI: 67.0-82.0; I(2) = 90.7), 56 diplopia (95 CI: 42.0-71.0; I(2) = 92.3), 49 cranial nerve palsy (95 CI: 32.0-66.0; I(2) = 95.1), 39 visual decline (95 CI: 32.0-45.0; I(2) = 71.4), 32 tinnitus (95 CI: 6.0-58.0; I(2) = 96.7), 29 elevated intraocular pain (95 CI: 22.0-36.0; I(2) = 0.0), 31 orbital or pre-orbital pain (95 CI: 14.0-48.0; I(2) = 89.9) and 24 headache (95 CI: 13.0-34.0; I(2) = 74.98). Coils, balloons, and stents were the three most used embolization methods respectively. Immediate complete occlusion of the fistula was seen in 68 of cases and complete remission was seen in 82. Recurrence of CCF occurred in only 35 of the patients. Cranial nerve paralysis after treatment was observed in 7 of the cases. CONCLUSIONS: Exophthalmos, Chemosis, proptosis, bruits, cranial nerve palsy, diplopia, orbital and periorbital pain, tinnitus, elevated intraocular pressure, visual decline and headache are the most common clinical manifestations of CCFs. The majority of endovascular treatments involved coiling, balloons and onyx and a high percentage of CCF patients experienced complete remission with the improvement of their clinical symptoms.

Item Type: Article
Creators:
CreatorsEmail
Rahmatian, A.UNSPECIFIED
Yaghoobpoor, S.UNSPECIFIED
Tavasol, A.UNSPECIFIED
Aghazadeh-Habashi, K.UNSPECIFIED
Hasanabadi, Z.UNSPECIFIED
Bidares, M.UNSPECIFIED
Safari-Kish, B.UNSPECIFIED
Starke, R. M.UNSPECIFIED
Luther, E. M.UNSPECIFIED
Hajiesmaeili, M.UNSPECIFIED
Sodeifian, F.UNSPECIFIED
Fazel, T.UNSPECIFIED
Dehghani, M.UNSPECIFIED
Ramezan, R.UNSPECIFIED
Zangi, M.UNSPECIFIED
Deravi, N.UNSPECIFIED
Goharani, R.UNSPECIFIED
Fathi, M.UNSPECIFIED
Keywords: Ccf Chemosis Diplopia Exophthalmos Proptosis Trauma Visual decline
Divisions:
Page Range: p. 100189
Journal or Publication Title: World neurosurgery: X
Journal Index: Pubmed
Volume: 19
Identification Number: https://doi.org/10.1016/j.wnsx.2023.100189
ISSN: 2590-1397 (Electronic) 2590-1397 (Linking)
Depositing User: مهندس مهدی شریفی
URI: http://eprints.medilam.ac.ir/id/eprint/4512

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