Clinical profiles and treatment outcomes of 51 cases of carotid cavernous fistula: a retrospective observational study.

Abstract

Purpose: This study investigated carotid-cavernous fistula (CCF) demographics, clinical profiles, imaging results, and treatment outcomes.

Methods: Our retrospective analysis included CCF patients' medical records from January 2016 to January 2022. This study included 51 cases-34 traumatic and 17 spontaneous CCFs.

Results: This study analyzed 51 patients with CCFs. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected males, while spontaneous CCF was more frequent in females (P=0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction and bruit (P=0.006 and P=0.008, respectively). According to the Barrow classification, all spontaneous CCF cases were categorized as Types B, C, or D, whereas traumatic CCF was predominantly classified as Type A (P<0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (P<0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches.

Conclusions: Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management.