Abstract
Ligation of the external carotid artery (ECA) and selective artificial embolization of the ECA and its branch have been applied to the spontaneous carotid cavernous fistula (SCCF). However, these techniques were not effective for the SCCF fed by the internal carotid artery (ICA). Moreover, ICA occlusion at the fistula of the low flow dural AVM has been reported to be risky. We have promoted complete spontaneous cure of the SCCF by repeated Matas' manipulations.
Case 1) A 65-year-old female was admitted to our clinic complaining of left proptosis, restricted eye movement, impaired visual acuity and chemosis. Serial and cineangiography revealed a left SCCF fed by the ICA through the meningohypophyseal trunk and drained into the ophthalmic veins. Matas' manipulation was applied to the left common carotid artery starting from 5 min/day and increased gradually to 20 min/day for four weeks. The symptoms subsided, and the shunt disappeared angiographically.
Case 2) A 66-year-old female was admitted to our clinic complaining of right oculomotor palsy, trigeminal neuralgia and slight proptosis. Serial and cineangiography revealed a right SCCF fed by the ICA through the meningohypophyseal truuk and drained into the petrosal sinuses. Matas' manipulation for 20 min/day was applied to the right common carotid artery for two weeks until the oculomotor palsy subsided. As pulsatory tinnitus appeared about a week later, Matas' manipulation for 30 min/day was continued every day for a month. Then the symptoms subsided, and the shunt disappeared angiographically. It seems worthwhile to try repeated Matas' manipulation prior to surgical and/or intravascular surgical intervention for SCCF.
