[Neuroradiological diagnosis and treatment of dural carotid-cavernous sinus fistulae (author's transl)]

Abstract

The neuroradiological diagnostic and therapeutic procedure in seven patients with nine dural fistulae between distal branches of the external carotid artery and the cavernous sinus is described. All patients had proptosis, signs of increased orbital venous pressure, and different degrees of pareses of the ocular muscles. During the diagnostic investigations selective angiographies of the internal and external carotid arteries and of the vertebral arteries were performed on both sides in order to exclude or to demonstrate branches of these vessels supplying the shunts. Subsequently those branches of the external carotid arteries feeding the fistulae were angiographied superselectively and embolized by repeated Gelfoam-injections during this same examination. Finally, the embolization of the shunts was proved by control angiographies in all cases. Following embolization, a pulse-synchronous bruit preexisting in four patients had disappeared. In all patients there was a complete remission of proptosis, signs of increased orbital venous pressure and blepharoedema within 2 weeks, and of the pareses of the ocular muscles within 4 to 6 weeks. After periodical control examinations at intervals of 4 to 6 weeks and during a period of 6 to 15 months none of the patients showed neurological deficits or signs of recurrence of the embolized fistulae. Superselective angiography and simultaneous embolization of dural carotid-cavernous sinus fistulae is therefore proposed as the current therapeutic procedure of choice for the treatment of these vascular malformations.