Spontaneous Carotid-Cavernous Fistulas

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Abstract
Seven patients with spontaneous carotid-cavernous fistulas are reported. Angiography showed a direct shunt between the internal carotid artery and the cavernous sinus in twc patients (Cases 2 and 6) and dural arteriovenous shunts in the cavernous sinus region in five patients (Cases 1, 3, 4, 5 and 7). They were treated by ligation of the external carotid artery (Cases 1 and 3), occlusion of the common carotid artery (Case 6), embolization of the fistula (Case 2), embolization and ligation of the external carotid artery and excision of the dural lesion (Case 5), embolization and ligation of the external carotid artery (Case 7), or irradiation (Case 4). Post-treatment angiography showed complete closure of the fistulas in four patients (Cases 1, 2, 4 and 7). In two patients (Cases 3 and 5), small angiomatous lesions were noted, one which regressed spontaneously one year postoperatively and one which improved clinically. We suggest that in surgically inaccessible shunts, irradiation may be a viable alternative treatment.
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