Classification and digital subtraction angiography evaluation of carotid cavernous fistulas

Objective To investigate the role of digital subtraction angiography (DSA) in evaluation of carotid cavernous fistulas, and to initiate a new classification for carotid cavernous fistula Methods Cerebral angiography and selective external and internal carotid angiography were carried out in 56 patients who were classified into 5 types according to their hemodynamic features Results The types were A (38 patients), B (4), C (10), D (2), and E (2) One of the 38 direct fistulas was located at C1 of the cavernous segment Fistulas at C2 were observed in 10 patients, at C3 in 4, at C4 in 10 and at C5 in 5 The anterior communicating arteries were patent and well compensated in 33 of the 56 patients The posterior communicating arteries were patent and well compensated in 39 patients Both communicating arteries were well compensated in 31 patients Fifty of the 56 patients were drained by ophthalmic veins, 47 by inferior petrous sinuses, 18 by cortical veins, and 8 to the posterior fossa region Conclusions Digital subtraction angiography was helpful in localization of the rents in carotid cavernous fistulas, in evaluation of function of Willis circles and provided valuable information for treatment of carotid cavernous fistulas Carotid cavernous fistulas were divided into 5 categories: type A, B, C, D and E, among which type E was not previously described elsewhere