[A new treatment by occluding spring embolus for carotid-cavernous fistula]

The authors describe a new technique for simple, direct and safe obliteration of a carotid cavernous fistula (CCF) with occluding spring embolus (OSE), preserving the carotid artery flow. The patient was 47 year-old man who was admitted to our department on September 3, 1984 complaining of left conjunctival injection, exophthalmos and bruit at the left temporal region. Angiograms revealed a typical cavernous dural AVM (spontaneous CCF) on the left side with bilateral dural ECA-ICA blood supply. He was treated with transvascular Ivalon embolization of the bilateral ECA. A clinical symptom after transvascular embolization improved transiently, but one month later he developed progressive chemosis in addition to the previous symptom. A left frontotemporal craniotomy was done and six OSEs through polyethylene tube was inserted into the cavernous sinus and the fistula was closed completely. Angiogram during procedure was taken to establish the topographical relationship of OSE, carotid artery and the cavernous sinus. Postoperatively his chemosis and conjunctival injection were decreased and gradually cleared up within three weeks. Postoperative angiogram showed complete closure of the fistula.