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Abstract - Original Article

J Cerebrovasc Endovasc Neurosurg. 2022 24(4): 356-365
The Journal of Cerebrovascular and Endovascular Neurosurgery
Carotid cavernous fistula: Redefining the angioarchitecture
Keshav Mishra1, Vivek Kumar2, Vinay3, Ashok Gandhi4, Trilochan Srivastava5
1Fellow Skull Based Surgeon, PGIMER Chandigarh, Haryana, India 2Department of Neurosurgery, Pt. B. D. Sharma, PGIMS Rohtak. Haryana, India 3Department of Community Medicine, Pt. B. D. Sharma, PGIMS Rohtak. Haryana, India 4Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India 5Department of Neurology, SMS Medical College and Hospital, Jaipur, Rajasthan, India

Objective: Numerous classification schemes have been used for carotid cavernous fistula (CCF), each describing some aspect of the disease process but none of them provides a complete description of the fistula including its clinical features, natural history, arterial and venous architecture. Methods: Retrospective clinical and radiological review was done for all the patients diagnosed with CCF and treated at our institute. The CCF were classified according to the proposed API-ACE classification along with Barrow and Thomas classification. Results: Overall 28 patients (M=21, F=7) were diagnosed and treated during the 6-year period. 89.2% of CCF developed following an episode of head injury. Orbital symptoms were the most common presenting complaints. Barrows type A was the most predominant subtype (n=24) and most of the patients (n=23) demonstrated decreased ipsilateral carotid filling. Combined anterior and posterior drainage pattern was the most common drainage pattern and anterior drainage was more commonly observed than posterior drainage. Conclusions: API-ACE classification helps to better understand and classify the angioarchitecture of CCF which could help better understand the clinical manifestations and guide in appropriate endovascular approach selection for treatment.
Key words : Carotid cavernous fistula (CCF), Thomas classification, Venous angioarchitecture

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