No abstract

Angiographic and clinical data from 155 patients with carotid cavernous fistulae were retrospectively reviewed to determine angiographic features associated with increased risk of morbidity and mortality. These features included presence of a pseudoaneurysm, large varix of the cavernous sinus, venous drainage to cortical veins, and thrombosis of venous outflow pathways distant from the fistula. Clinical signs and symptoms that characterized a hazardous carotid cavernous fistula included increased intracranial pressure, rapidly progressive proptosis, diminished visual acuity, hemorrhage, and transient ischemic attacks. Cortical venous drainage from the carotid cavernous fistula is secondary to occlusion or absence of the normal venous outflow pathways and is associated with signs and symptoms of increased intracranial pressure and an increased risk of intraparenchymal hemorrhage. Angiographic demonstration of a cavernous sinus varix, with extension of the sinus into the subarachnoid space, is associated with an increased risk of fatal subarachnoid hemorrhage. Identification of these high-risk features provides a basis for making decisions about treatment.

InterventionalNeuroradiology Section, 505 Pamassus Ave., L-352, San Francisco, CA 941 43. Address reprint requests to A. T. Higashida.

No abstract

Twenty-eight symptomatic dural fistulas involving the transverse and sigmoid sinuses were treated between 1978 and 1986 with a variety of treatment modalities. Occipital artery compression therapy resulted in a complete cure in two of nine patients (22%) and improvement in three of nine (33%). There were no complications from this treatment. Patients who were excluded or in whom compression therapy failed were treated with embolization alone or in conjunction with surgery. Of the 17 patients who underwent embolization alone, ten were cured and six were improved. Six patients had a combination of embolization and surgery; four patients were cured and two improved. There were three complications in this series, one related to surgery and two related to embolization.