Treatment of Spontaneous Carotid-cavernous Fistula

The so called “spontaneous” carotid-cavernous fistulae are mostly dural shunts between the meningeal branches of internal or external carotid arteries and dural veins in the vicinity of cavernous sinus. The spontaneous external carotid-cavernous fistula could be treated by ligation or embolization of branches of external carotid artery. On the other hand, the direct closure of internal carotid-cavernous fistula is quite a challenge to neurosurgeons. Here is a report of a technique for direct closing of a spontaneous internal carotid-cavernous fistula which does not impair internal carotid blood flow. Exposure of cavernous sinus wall is achieved by means of a frontotemporal craniotomy. Operative angiography is performed in order to establish the topographical relationship of internal carotid artery, Parkinson's triangle of the cavernous sinus and fistula. Fine copper on copper compound wire is threaded transdurally into the lumen of the sinus. A direct current (0.2 mA to 2 mA) is applied to the copper wire for 1 to 2 minutes. The closure of fistula is verified by operative angiograms. Our experiences of the three cases suggest that electrothrombosis is an ideal treatment of spontaneous internal carotid-cavernous fistula.