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Daniel L. Barrow, Robert H. Spector, Ira F. Braun, Jeffrey A. Landman, Suzie C. Tindall and George T. Tindall

✓ An anatomical-angiographic classification for carotid-cavernous sinus fistulas is introduced and a series of 14 patients with spontaneous carotid-cavernous sinus fistulas is reviewed to illustrate the usefulness of such a classification for patient evaluation and treatment. Fistulas are divided into four types: Type A are direct high-flow shunts between the internal carotid artery and the cavernous sinus; Type B are dural shunts between meningeal branches of the internal carotid artery and the cavernous sinus; Type C are dural shunts between meningeal branches of the external carotid artery and the cavernous sinus; and Type D are dural shunts between meningeal branches of both the internal and external carotid arteries and the cavernous sinus. The anatomy, clinical manifestations, angiographic evaluation, indications for therapy, and therapeutic options for spontaneous carotid-cavernous sinus fistulas are discussed.

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Neil R. Miller

: Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 62: 248–256, 1985 8 Benndorf G , Bender A , Campi A , Menneking H , Lanksch WR : Treatment of a cavernous sinus dural arteriovenous fistula by deep orbital puncture of the superior ophthalmic vein. Neuroradiology 43: 499–502, 2001 9 Benndorf G , Bender A , Lehmann R , Lanksch W : Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature. Surg Neurol 54: 42

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Kazuhiko Nishino, Yasushi Ito, Hitoshi Hasegawa, Bumpei Kikuchi, Junsuke Shimbo, Keiko Kitazawa and Yukihiko Fujii

occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature . Surg Neurol 54 : 42 – 54 , 2000 5 Cheng KM , Chan CM , Cheung YL : Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases . Acta Neurochir (Wien) 145 : 17 – 29 , 2003 6 Drake CG : Giant intracranial aneurysms: experience with surgical treatment in 174 patients . Clin Neurosurg 26 : 12 – 95 , 1979 7 Halbach VV , Higashida RT , Hieshima GB

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Akira Kurata, Sachio Suzuki, Kazuhisa Iwamoto, Kuniaki Nakahara, Madoka Inukai, June Niki, Kimitoshi Satou, Masaru Yamada, Kiyotaka Fujii, Shinichi Kan and Toshiro Katsuta

– 160 , 2004 2 Benndorf G , Bender A , Lehmann R , Lanksch W : Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature . Surg Neurol 54 : 42 – 54 , 2000 3 Bošković M , Savić V , Josifov J : Über die Sinus Petrosi und ihre Zuflüsse . Gengenbaurs Morphol Jahrb 104 : 420 – 429 , 1963 4 Cheng KM , Chan CM , Cheug YL : Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases

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Juan Pablo Cruz, Rene van Dijk, Timo Krings and Ronit Agid

manuscript on behalf of all authors: Agid. References 1 Agid R , Willinsky RA , Haw C , Souza MPS , Vanek IJ , terBrugge KG : Targeted compartmental embolization of cavernous sinus dural arteriovenous fistulae using transfemoral medial and lateral facial vein approaches . Neuroradiology 46 : 156 – 160 , 2004 2 Benndorf G , Bender A , Lehmann R , Lanksch W : Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature . Surg Neurol 54

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Cheng-Chia Lee, Ching-Jen Chen, Shao-Ching Chen, Huai-Che Yang, Chung Jung Lin, Chih-Chun Wu, Wen-Yuh Chung, Wan-Yuo Guo, David Hung-Chi Pan, Cheng-Ying Shiau and Hsiu-Mei Wu

occlusions, 1 partial occlusion progressed to anatomical cure at 7 mos None Clival DAVFs can be misdiagnosed as dural cavernous sinus fistulas; best treatment is transarterial embolization of dural feeders using liquid embolic agents; transvenous occlusion of cavernous sinus unnecessary in most cases Tirakotai et al., 2005 (4) Surgery Transcondylar approach 3 complete obliterations, 1 significant flow reduction 1 Occipitocervical fusion may be needed due to extensive bone drilling Ernst et al., 1999 (3) Embolization Coil in 2 cases (transvenous), combined coil (transvenous