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V. Vinh, V. Lefournier, P. Bessou, F. Bernal, A. Vasdev, M. Mouillon, C. Chiquet, J.–P. Romanet; Dural Carotid–Cavernous Fistulas: The Evolution of the Therapeutic Strategy From 1989 to 2004. About 12 Cases . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5715.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare the therapeutic choices used to treat dural carotid–cavernous fistulas in the late 80’s and mid 90’s to the therapeutic strategy currently favoured. Methods: A retrospective study of twelve patients who underwent examination and treatment for dural carotid–cavernous fistulas between 1989 and 2004 was performed. All had an ophthalmologic examination and the diagnosis was angiographically confirmed. Three patients had Type B dural carotid–cavernous fistulas and 9 had Type D. Until 1997, non–invasive treatment modalities such as decoagulation and/or carotid–jugular compressions were first initiated, followed by embolization. In contrast, between 2003–2004, embolization was favoured and performed as the initiale procedure followed by decoagulation and/or compressions as indicated. Results: Among the four patients treated between 1989 and 1997, three just had decoagulation and/or compressions with clinical improvement in two cases compared to one unchanged case. The fourth patient underwent embolization after non–invasive treatment resulting in a clinical and angiographical cure. Among the eight patients treated between 2003–2004, one patient (for whom embolization was anatomically not possible and compressions contraindicated and who only had a decoagulation) remained clinically unchanged compared to four patients who received non–invasive treatment modalities resulting in minimal clinical improvement in two patients and a complete cure in the remaining two patients. Three patients underwent prior embolization followed by decoagulation and/or compressions leading to a dramatic clinical improvement in two patients and a complete cure in the remaining one patient. Conclusions: Prior embolization when possible appears to be an efficient and safe treatment mode of dural carotid–cavernous fistulas. Nonetheless, non–invasive treatment options particularly compressions remain an important therapeutic alternative.
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