[Spontaneous carotid-cavernous sinus fistula; analysis of 16 cases]

We have encountered 16 cases with spontaneous carotid-cavernous sinus fistula. According to the classification reported by Barrow, one case was type A; direct shunt between the internal carotid artery (ICA) and the cavernous sinus (CS), 5 were type B; dural shunt between meningeal branches of the ICA and the CS, 6 were type C; dural shunt between meningeal branches of the external carotid artery (ECA) and the CS, and 4 were type D; dural shunt between meningeal branches of both ICA and ECA and CA. Of all cases, 8 patients with low-flow fistula treated conservatively improved spontaneously. Three patients were treated with irradiation. Consequently, good results were obtained in 2 cases, but no improvement could be obtained in the remaining one with high flow fistula. Another four patients were treated with intravascular embolization via the ECA, and their symptoms improved. But one patient treated with Ivalon embolization died because of complicated pulmonary embolism. As spontaneous CCF had a high rate of spontaneous regression of symptoms, conservative treatment such as Matas maneuver or irradiation should be recommended at first for low flow cases in type B, C, and D. Surgical therapy such as intravascular embolization should be carried out for high-flow cases in type C and D.