Stereotactic gamma surgery combined with endovascular surgery fortreatment of a spontaneous carotid cavernous sinus fistula.

A Barrow type D carotid cavernous sinus fistula (CCF) with varices proved unamenable to endovascular surgery. Follow-up angiography showed a persistent CCF fed by a recurrent meningeal branching of the ophthalmic artery division with drainage into the ophthalmic vein, resulting in a secondary glaucoma and central retinal thrombosis. Stereotactic gamma surgery was successfully performed, and aggravation of the visual symptoms was prevented. The CCF disappeared and intraocular pressure normalized one month after the radiosurgery. Stereotactic radiosurgery is thus an appropriate treatment for cavernous sinus dural arteriovenous fistulas resistant to endovascular treatment, especially with small, slow flow target residual fistulas. [ABSTRACT FROM AUTHOR]

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