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.
- Barrow Type A
- Torn wall of cavernous carotid artery (collagen vascular disease)
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.