Barrow classification of caroticocavernous fistulae

A.Prof Frank Gaillard et al.

Barrow caroticocavernous fistula classification divides caroticocavernous fistulas into direct (type A) or indirect (types B-D). This classification was proposed by Barrow et al. in 1985 1 and at the time of writing (mid 2016) remains the most widely used system for describing caroticocavernous fistulas. Indirect fistulae are further subdivided according to whether supply is from the internal carotid artery, external carotid artery, or both. 

Classification

  • type A (most common 2): a direct connection between the...
    • intracavernous internal carotid artery, and the...
    • cavernous sinus
  • type B: dural shunt (indirect) between the...
    • meningeal branches of the intracavernous internal carotid artery, and the...
    • cavernous sinus
  • type C: dural shunt  (indirect) between...
    • meningeal branches of the external carotid artery, and the... 
    • cavernous sinus
  • type D: dural shunt  (indirect) between both...
    • meningeal branches of the intracavernous internal carotid artery (type B), and the...
    • meningeal branches of the external carotid artery (type C), and the... 
    • cavernous sinus

Alternative classifications

Tomsick et al have further proposed dividing type D in D1 (unilateral supply) and D2 (bilateral supply) 4

In 2015 Thomas et al. proposed an alternative classification system based on venous drainage 3.

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Article information

rID: 4018
Synonyms or Alternate Spellings:
  • Caroticocavernous fistula classification (Barlow)

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Cases and figures

  • Case 1: type A (direct) CCF
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