[An attempt of electrothrombosis of carotid-cavernous fistula (author's transl)]

Abstract

The patient was 50 year-old female who was admitted to our department on June 13, 1973 complaining of left conjunctival injection and ipsilateral exophthalmos. Visual acuity of her right eye had been lost almost completely due to the previous ocular injury. Ophthalmological examination revealed left conjunctival injection, slight ipsilateral proptosis but pulsation of eye ball, chemosis and bruit were not so obvious. She had a visual acuity of 1.2 on her left eye. Left intraocular pressure was 30 mmHg while right was normal. Left CAG revealed a left carotid-cavernous fistula with anterior, posterior, inferior venous drainage. Temporal craniotomy was done and copper needles were inserted into the posterior part of Parkinson's triangle. An angiogram after operation demonstrated the persistency of the anterior and posterior venous drainage. 6 weeks later, electrothrombosis of left superior ophthalmic vein was carried out. After that, carotid-cavernous fistula disappeared perfectly. Important points of the surgical technique are; 1) to apply a silverclip to the tentorial edge just posterior to the third nerve, than anatomical realtionship of internal carotid artery, cavernous sinus and the clip applied are carefully investigated on the subsequent angiograms. 2) to repeat angiography several titate of embolization of cavernous sinus should often be checked.