Carotis-Cavernosus-Fisteln: Diagnostik und Therapie

Zusammenfassung

Carotis-Cavernosus-Fisteln (CCF) machen etwa 12 % aller intrakraniellen arteriovenösen Fisteln aus und bestehen aus einer pathologischen Verbindung zwischen der Arteria carotis interna und/oder externa und dem Sinus cavernosus. In Abhängigkeit von der Anatomie und Pathophysiologie unterscheidet man zwischen direkten, meist traumatisch bedingten „High-flow”- und indirekten „Low-flow”-Fisteln. In beiden Fällen besteht die Behandlung in der Regel im endovaskulären Fistelverschluss, welcher seit den Fortschritten in der interventionellen Neuroradiologie während den letzten 15 Jahren die chirurgische Therapie weitgehend abgelöst hat. Diese Arbeit gibt eine Übersicht über die Anatomie und Pathophysiologie dieser Läsionen sowie über den aktuellen Stand der endovaskulären Behandlungsmöglichkeiten. Es werden Indikationen, Techniken und Ergebnisse interventioneller Eingriffe bei verschiedenen Typen von CCF dargestellt.

Abstract

This article provides an overview on the actual state of the interventional neuroradiological management of carotid cavernous fistulas depending on their anatomy and pathophysiology. The results are based on our experience gained during the treatment of patients with complex CCF during the last 15 years. Indications, procedures, and results of transarterial, transvenous and combined arteriovenous approaches for balloon occlusion, embolization, coiling and stenting of these lesions are discussed. Progress in this field is constant so that new technical advances are expected to improve the safety and to expand the indications for these procedures in the future.

Key words

carotid arteries - fistula - cerebral angiography - embolization - balloon insertions - stents

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