Carotid cavernous fistula with cervical myelopathy

We report a patient with carotid cavernous fistula (CCF) presenting with cervical myelopathy. The patient initially presented with ocular pain accompanied by binocular diplopia and was diagnosed with Tolosa-Hunt syndrome at another institution. This patient experienced long-standing venous hypertension due to the delay in diagnosis. Posterior venous drainage from the CCF caused venous congestion in the brainstem and cervical spinal cord causing cervical myelopathy. Glue embolization using n-butyl-2-cyanoacrylate was attempted, but only partial embolization was possible because access to feeding arteries was limited. Stereotactic gamma-knife radiosurgery was performed as an alternative treatment, and effectively obliterated the CCF. However, the patient remained disabled due to cervical cord atrophy associated with long-standing venous hypertension.