Korean J Cerebrovasc Dis.  2000 Mar;2(1):77-83.

Treatment of Indirect Carotid Cavernous Fistulas(Type D)

• Kim JH
• Lee CY
• Yim MB

Abstract

OBJECTS: Type D indirect carotid cavernous fistulas(CCFs) have been known to be challenging and problematic in its treatment. We present three cases of type D indirect CCFs treated successfully by transvenous balloon embolization through the superior ophthalmic vein (SOV) and radiotherapy. MATERIAL AND METHODS: All of these patients presented with proptosis, chemosis, diplopia and elevated intraocular pressure. The duration of symptoms until treatment of the these patients was 3 months, 4 months and 4 years respectively. Of these patients, two patients were treated successfully by transvenous balloon embolization through the ipsilateral SOV into the cavernous sinus and one patient, had previously been treated unsuccessfully by transvenous embolization via the SOV, was treated by radiotherapy delivering 3600 cGy.
RESULTS
All patients had complete resolution of symptoms and signs after the treatments. There were no intraoperative complication, however, two patients who were treated by transvenous embolization via the SOV had transient oculomotor nerve palsy which had improved completely later. None of the three patients developed recurrent symptoms and signs suggesting recurrence of the fistula during a follow-up period that ranged from 12 months to 25 months.
CONCLUSION
We think that transvenous embolization through the SOV and radiotherapy can be a safe and successful means of treating type D indirect CCFs.

Keyword

Carotid-cavernous fistula; Indirect; Type D; Embolization; Superior ophthalmic vein; Radiotherapy

MeSH Terms

Balloon Occlusion
Cavernous Sinus
Diplopia
Exophthalmos
Fistula
Follow-Up Studies
Humans
Intraocular Pressure
Intraoperative Complications
Oculomotor Nerve Diseases
Radiotherapy
Recurrence
Veins