Barrow Classification of Carotid-Cavernous Fistulas

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Carotid cavernous fistulas can be first classified by whether they are traumatic (including iatrogenic) or spontaneous. Spontaneous Carotid-Cavernous Fistulas are classified into the following groups:

  • A. DIRECT HIGH FLOW shunt between ICA and cavernous sinus. Often from ruptured cavernous ICA aneurysm.
  • B. INDIRECT LOW FLOW dural shunts between meningeal branches of the ICA and the cavernous sinus.
  • C. INDIRECT LOW FLOW dural shunts between meningeal branches of the ECA and the cavernous sinus.
  • D. INDIRECT LOW FLOW dural shunts between meningeal branches of both the ICA and ECA and the cavernous sinus.

Another way to consider carotid-cavernous fistulas is by whether they are direct or indirect.

DIRECT

  • Traumatic
  • Barrow Type A
  • Torn wall of cavernous carotid artery (collagen vascular disease)

INDIRECT

Barrow Types B-D

REFERENCE. Barrow DL, Spector RH, Braun IF, et al.: Classification and treatment of spontaneous carotid-cavernous fistulas. J Neurosurg 62: 248-56, 1985.

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