Transorbital Color Doppler Imaging of Spontaneous Carotid Cavernous Fistulas before and after Embolization.

概要

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The treatment of spontaneous carotid cavernous fistulas (CCF) has been a challenging problem for neurosurgeons. Recently, with the advent of refined microcatheters and various kinds of embolic materials, endovascular surgery has become the treatment of choice. After embolization, follow-up study is indispensable, because thrombosis of fistulas may continue after the procedure, or reopening of the occluded vessels may occur. The purpose of this study was to evaluate the usefulness of transorbital color Doppler imaging (CDI) as a tool for the diagnosis and follow-up of CCF.<BR>CDI offers simultaneous two-dimensional structural imaging and Doppler measurement of blood flow. Four patients with spontaneous CCF were examined by this technique. CDI demonstrated a dilated superior ophthalmic vein (SOV) with reversed direction of blood flow in all of the patients. They underwent occlusion of the fistula by transvenous embolization with platinum coils. Postembolization CDI revealed shrinkage of the SOV in all cases.<BR>In conclusion, CDI provides a noninvasive means of confirming the presence of CCF, and assists in the evaluation of hemodynamics of carotid cavernous fistulas after endovascular surgery.