[Copper needle insertion for the treatment of spontaneous carotid cavernous fistula]

Electrothrombosis by copper needle insertion was applied to three cases of spontaneous carotid cavernous fistula. These cases had been observed conservatively for about six months or more, but their symptoms did not improve. On angiogram, the feeding arteries were branches of both the ipsilateral internal and the external carotid artery. Frontotemporal craniotomy was performed and copper needles were inserted transdurally into the cavernous sinus. The closure of fistula was verified by intra-operative angiography in all cases and their symptoms improved after operation. However, postoperatively one case had transient third nerve palsy. Another case had Gerstmann syndrome due to narrowing of the internal carotid artery by one needle and the preoperative six nerve palsy became worse. In one case, the procedure could be uneventfully performed. Based on our experiences, several problems of this technique were discussed in this paper.