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Yoshio Hosobuchi

T his paper describes a method for closure of carotid cavernous fistulas by copper electrothrombosis, and reports four cases in which closure was achieved with preservation of the internal artery circulation. Methods Introduction of Copper Wire through Superior Ophthalmic Vein A dilated superior ophthalmic vein receiving arterial blood can easily be identified through simple incisions of the upper eyelid. The vein is cannulated with a polyethylene, barium-impregnated catheter which is advanced to the cavernous sinus under radiographic control. Size

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Jason A. Ellis, Hannah Goldstein, E. Sander Connolly Jr. and Philip M. Meyers

relevant, both in terms of the spread of extracranial infections and neoplasms and as alternative routes for venous drainage in patients with obstruction of the cavernous sinus. 6 Fistula Classification Carotid-cavernous fistulas are abnormal vascular shunts, allowing blood to flow either directly or indirectly from the carotid artery into the cavernous sinus. Carotid-cavernous fistulas have been classified according to the hemodynamic properties, etiology, or anatomy of the fistula ( Table 1 ). Hemodynamic classification separates CCFs into high-flow and low

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Perry Black, Sumio Uematsu, Milos Perovic and A. Earl Walker

I n 1931, for the treatment of carotid-cavernous fistula, Brooks 2 introduced the method of embolization via the cervical carotid artery to tamponade the carotid siphon and thereby occlude the fistula. Hamby and Gardner 6 later reported a modification of Brooks' procedure by using a 5-mm ball-shaped embolus intended to lodge in the fistula. In the past 30 years, management has consisted mainly of trapping the fistula, with 4, 5 or without 15 embolization of a large strip of muscle or artificial material. 3, 9, 10, 13, 17 Russian authors 1 have used a

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Dwight Parkinson

T he carotid cavernous fistula has been recognized for nearly as long as arteriovenous fistulas of the extremities, but as Hamby 1 states, “…its management remains unsatisfactory. As in other parts of the body the fistula itself should be attacked rather than attempting piecemeal progressive ligation of its feeding arteries.” Treatment of arteriovenous fistulas of the extremities has progressed from single vessel ligation to multiple vessel ligation and then to bloc resection; 3, 4 now repair of the fistula with preservation of the artery is the accepted

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Sean Mullan

awaits development. Subsequent experience suggests that it is preferable to the combined copper and beryllium copper method. Better selection of patients is always certain to improve results, and a better method is needed for determining which aneurysm has bled in patients who have multiple aneurysms (Case 8). Thrombosis of Carotid Cavernous Fistula, Stereotaxic and Open Methods For many years we have sought a better way of controlling carotid cavernous fistulae. A significant rate of failure in addition to the recognized morbidity and mortality of any

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Mohamed Samy Elhammady, Eric C. Peterson and Mohammad Ali Aziz-Sultan

Postoperatively the patient recovered well and had no perioperative complications. At the 3-month follow-up her intraocular pressure was 18 mm Hg and a cerebral angiogram showed persistent occlusion of the fistula. Discussion Carotid cavernous fistulas are abnormal connections between the internal and/or external CA and the cavernous sinus. Advances in catheters and embolic materials have made endovascular embolization the preferred method of intervention for treatment of these lesions. The goal of treatment is obliteration of the fistulous connection to decrease the

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Alberto Gil, Luis López-Ibor, Gerardo Lopez-Flores, Hugo Cuellar, Eduardo Murias and Gregorio Rodríguez-Boto

E ndovascular treatment is the treatment of choice for indirect carotid cavernous fistulas (CCFs). Usually, the pathological cavernous sinus is occluded through the inferior petrosal sinus. In cases of failure of the transvenous approach, alternatives include percutaneous puncture of accessible veins, such as the superior ophthalmic vein. However, when these structures are not patent, direct surgical exposure of the cavernous sinus is required, especially in highly symptomatic patients or in those with an aggressive pattern of venous drainage. In one such

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José-Maria de Campos, Mario O. López Ferro, Juan A. Burzaco and José R. Boixadós

T he pathogenesis of spontaneous carotid-cavernous fistula (CCF) has been discussed by different authors. According to Lazorthes, 18 the condition is due to spontaneous rupture of a previous cavernous-carotid aneurysm. These fistulas may be congenital, traumatic, or arteriosclerotic in origin. Taptas 27 supports the idea of the preexistence of nonfunctioning arteriovenous communications in the cavernous area between minor branches of the internal carotid artery and veins that form the pericarotid venous plexus. Under a variety of circumstances, these

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Donn M. Turner, John C. Vangilder, Saeid Mojtahedi and Eric W. Pierson

H emorrhage associated with carotid-cavernous fistula (CCF) has been reported to occur in 3% of patients. 12, 34, 44 Although CCF has long been recognized as a threat to vision, only a few authors have documented the danger of spontaneous rupture of the fistula. 9, 11, 33, 34, 39, 44 In this paper, we report three cases of spontaneous intracerebral hematoma in patients with CCF's. In each case, the hemorrhage occurred in the vicinity of localized venous engorgement, as demonstrated by cerebral angiography. A mechanism for the bleeding is proposed, and the

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Laligam N. Sekhar, Roberto C. Heros and Charles W. Kerber

encountered two cases of carotid-cavernous fistula following percutaneous retrogasserian procedures. One of these occurred after a local anesthetic injection into Meckel's cave, and the other after percutaneous radiofrequency rhizotomy. To our knowledge, these are the first such cases ever reported in the literature. Embolization Technique for Fistula Repair Occlusion of the fistulas in both cases was performed using the technique of Kerber, et al. 5 Two catheters are placed in the ICA by percutaneous techniques. The femoral route is perferred, although one catheter