Abstract
Six cases of spontaneous carotid-cavernous fistulas of the dural arteriovenous malformation type were treated with the transvenous approach via the inferior petrosal sinus. Copper coils were mainly used as the embolic agent, but in two cases platinum coils were also tried. Catheterization through the inferior petrosal sinus into the cavernous sinus was successful in all cases, including a case in which the sinus was not opacified by the angiogram.
Immediate disappearance of fistulas was angiographically demonstrated in all cases. Bruit and exophthalmos disappeared immediately. Temporal aggravation of chemosis was observed in three cases after the embolization but disappeared within two weeks. Visual symptoms caused by the cranial nerve paresis gradually improved. No severe complications were observed, but pains around the retro-orbital and the fronto-temporal region were aggravated in all, which were controllable with medications and disappeared within 2 weeks. No recurrence was observed during an average follow-up period of 10.3 months. This method is considered to be a promising treatment for spontaneous carotid-cavernous fistulas of the dural arteriovenous malformation type.
