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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(03): e210-e214
DOI: 10.1055/s-0038-1657775
Original Article | Artigo Original

Surgical Treatment of Carotid-cavernous Fistula Performed through the Brazilian Unified Health System

Tratamento cirúrgico de fístula carotídeo-cavernosa realizado por meio do Sistema Único de Saúde
Ilanna Sobral de Luna
1   Departament of Neurology, Faculdade de Medicina, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil
,
Airan Lobo da Costa
2   Departament of Neurology, Faculdade de Medicina, Universidade do Oeste Paulista, São Paulo, São Paulo, Brazil
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Abstract

Introduction The carotid-cavernous fistula (CCF) is an abnormal communication between the arterial carotid system and the cavernous sinus. In most cases, spontaneous fistulas are due to the rupture of intracavernous carotid artery aneurisms. Traumatic fistulas occur in 0.2% of head injuries, and 75% of all CCFs are caused by automobile accidents or penetrating traumas.

Objective To identify the data regarding the number of annual procedures, hospital expenses, length of hospital stay, and the number of deaths of patients admitted by the Brazilian Unified Health System (SUS, in the Portuguese acronym), in the period between 2007 and 2017, using the surgical code of the surgical treatment for CCF.

Methods The present was an ecological study whose data were obtained by consulting the database provided by the Department of Computer Sciences of the Brazilian Unified Health System (Datasus, in Portuguese).

Results A total of 85 surgical procedures were performed for the treatment of CCFs from January 2007 to October 2017 through the Unified Health System (SUS, in Portuguese), and there was a reduction of 71.42% in this period. The annual incidence of patients undergoing this surgical treatment during the period observed remained low, with 1 case per 13,135,714 in 2007, and 1 case per 51,925,000 in 2017.

Conclusion Despite the low annual incidence of the surgical treatment of CCFs performed by the SUS in Brazil in the period of 2007–2017, based on the data obtained on the average length of stay and expenditures in hospital services, it is necessary that we develop an adequate health planning.

Resumo

Introdução A fístula carotídeo-cavernosa (FCC) é uma comunicação anormal entre o sistema carotídeo e o seio cavernoso. Na maioria dos casos, as fístulas espontâneas ocorrem por ruptura de aneurismas intracavernosos da artéria carótida interna. As fístulas traumáticas ocorrem em cerca de 0,2% dos traumatismos cranioencefálicos, sendo que 75% de todas as FCCs são causadas por traumas penetrantes ou acidentes automobilísticos.

Objetivo Identificar os dados a respeito do número de procedimentos anuais, os gastos hospitalares, o tempo de internação, e o número de óbitos dos pacientes admitidos pelo Sistema Único de Saúde (SUS), no período de 2007 a 2017, utilizando o código cirúrgico de tratamento cirúrgico de FCC.

Métodos Trata-se de um estudo ecológico, cujos dados foram obtidos por meio de consulta à base de dados disponibilizada pelo Departamento de Informática do SUS (Datasus).

Resultados Foram realizados 85 procedimentos cirúrgicos para tratamento de FCC de janeiro de 2007 a outubro de 2017 por meio do SUS, e ocorreu uma redução de 71,42% neste período. A incidência anual dos pacientes submetidos a este tratamento cirúrgico durante o período observado continuou baixa, apresentando 1 caso para cada 13.135.714 em 2007, e 1 caso para cada 51.925.000 em 2017.

Conclusão Apesar da incidência anual do tratamento cirúrgico de FCC realizado pelo SUS no Brasil no período de 2007 a 2017 ter sido baixa, a partir dos dados obtidos sobre a média de permanência e gastos em serviços hospitalares, é necessário um planejamento adequado em saúde.

Keywords

carotid-cavernous fistula - Brazilian unified health system - health care

Palavras-chave

fístula carotídeo-cavernosa - sistema único de saúde - assistência à saúde


Publication History

Received: 05 January 2017

Accepted: 24 April 2017

Article published online:
21 June 2018

© 2018. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Kim J-W, Kim S-J, Kim M-R. Traumatic carotid-cavernous sinus fistula accompanying abducens nerve (VI) palsy in blowout fractures: missed diagnosis of ‘white-eyed shunt’. Int J Oral Maxillofac Surg 2013; 42 (04) 470-473
    CrossrefPubMedGoogle Scholar
  • 2 Shinohara Y, Kashima T, Akiyama H, Kishi S. Alteration of choroidal thickness in a case of carotid cavernous fistula: a case report and a review of the literature. BMC Ophthalmol 2013; 13 (01) 75
    CrossrefPubMedGoogle Scholar
  • 3 Carneiro Jr JT, Paschoal EHA, Carreira ASD, Real RPV. Carotid cavernous fistula after surgically assisted rapid maxillary expansion with a bone anchored appliance. Int J Oral Maxillofac Surg 2013; 42 (03) 326-328
    CrossrefPubMedGoogle Scholar
  • 4 Vilela MAP. Carotid-cavernous fistula. Rev Bras Oftalmol 2013; 72 (01) 70-75
    CrossrefPubMedGoogle Scholar
  • 5 Tanweer O, Raz E, Brunswick A. et al. Cavernous carotid aneurysms in the era of flow diversion: a need to revisit treatment paradigms. AJNR Am J Neuroradiol 2014; 35 (12) 2334-2340
    CrossrefPubMedGoogle Scholar
  • 6 Kashiwazaki D, Kuwayama N, Akioka N, Kuroda S. Delayed abducens nerve palsy after transvenous coil embolization for cavernous sinus dural arteriovenous fistulae. Acta Neurochir (Wien) 2014; 156 (01) 97-101
    CrossrefPubMedGoogle Scholar
  • 7 Chi CT, Nguyen D, Duc VT, Chau HH, Son VT. Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases. Interv Neuroradiol 2014; 20 (04) 461-475
    CrossrefPubMedGoogle Scholar
  • 8 Turfe ZA, Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis. J Neurointerv Surg 2015; 7 (04) 250-255
    CrossrefPubMedGoogle Scholar
  • 9 Linfante I, Lin E, Knott E, Katzen B, Dabus G. Endovascular repair of direct carotid-cavernous fistula in Ehlers-Danlos type IV. J Neurointerv Surg 2015; 7 (01) e3
    CrossrefPubMedGoogle Scholar
  • 10 Barnwell SL, O'Neill OR. Endovascular therapy of carotid cavernous fistulas. Neurosurg Clin N Am 1994; 5 (03) 485-495
    CrossrefPubMedGoogle Scholar
  • 11 Xu X-Q, Liu S, Zu Q-Q. et al. Follow-up of 58 traumatic carotid-cavernous fistulas after endovascular detachable-balloon embolization at a single center. J Clin Neurol 2013; 9 (02) 83-90
    CrossrefPubMedGoogle Scholar
  • 12 Korchi AM, Cuvinciuc V, Caetano J, Becker M, Lovblad KO, Vargas MI. Imaging of the cavernous sinus lesions. Diagn Interv Imaging 2014; 95 (09) 849-859
    CrossrefPubMedGoogle Scholar
  • 13 Chin OY, Ghosh R, Fang CH, Baredes S, Liu JK, Eloy JA. Internal carotid artery injury in endoscopic endonasal surgery: A systematic review. Laryngoscope 2016; 126 (03) 582-590
    CrossrefPubMedGoogle Scholar
  • 14 Rodrigues T, Willinsky R, Agid R, TerBrugge K, Krings T. Management of dural carotid cavernous fistulas: a single-centre experience. Eur Radiol 2014; 24 (12) 3051-3058
    CrossrefPubMedGoogle Scholar
  • 15 Gölitz P, Struffert T, Lücking H. et al. Parametric color coding of digital subtraction angiography in the evaluation of carotid cavernous fistulas. Clin Neuroradiol 2013; 23 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 16 Chen C-J, Lee C-C, Ding D. et al. Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review. J Neurosurg 2015; 122 (02) 353-362
    CrossrefPubMedGoogle Scholar
  • 17 Ducruet AF, Albuquerque FC, Crowley RW, McDougall CG. The evolution of endovascular treatment of carotid cavernous fistulas: a single-center experience. World Neurosurg 2013; 80 (05) 538-548
    CrossrefPubMedGoogle Scholar
  • 18 Luo C-B, Teng MM-H, Chang F-C, Lin C-J, Guo W-Y, Chang C-Y. Transarterial detachable coil embolization of direct carotid-cavernous fistula: immediate and long-term outcomes. J Chin Med Assoc 2013; 76 (01) 31-36
    CrossrefPubMedGoogle Scholar
  • 19 Lin L-M, Colby GP, Jiang B, Pero G, Boccardi E, Coon AL. Transvenous approach for the treatment of direct carotid cavernous fistula following Pipeline embolization of cavernous carotid aneurysm: a report of two cases and review of the literature. J Neurointerv Surg 2015; 7 (08) e30
    CrossrefPubMedGoogle Scholar
  • 20 Tomasi E, Facchini LA, Piccini RX. et al. Perfil sócio-demográfico e epidemiológico dos trabalhadores da atenção básica à saúde nas regiões Sul e Nordeste do Brasil. Cad Saude Publica 2008; 24 (01) 193-201
    CrossrefPubMedGoogle Scholar
  • 21 Kim MJ, Shin YS, Ihn YK. et al. Transvenous embolization of cavernous and paracavernousdural arteriovenous fistula through the facial vein: report of 12 cases. Neurointervention 2013; 8 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 22 Borba R, Sonda I, Dini LI, Calcagnotto FN, Marchett N, Cobalchini PC. Fístula carótido-cavernosa com epistaxe letal: relato de caso. Arq Neuropsiquiatr 2001; 59 (2-A): 276-279
    CrossrefPubMedGoogle Scholar