Radiosurgery of carotid-cavernous fistulae

25 cases of carotid-cavernous fistulae (CCF) who underwent radiosurgery with a conventional gamma source from 1977 to 1992 are reported. 22 were low-flow, spontaneous CCFs and 3 were high flow fistulae which had undergone a previous trapping. The total dose delivered was 30 to 40 Gy. 91% to patients with low-flow CCF cured after radiosurgery in a mean time of 7.5 months, presenting improvement in a mean time of 2.3 months. Only one of the high-flow fistulae was cured. Follow-up period ranged between 14 years and 15 months (mean: 50 months). No recurrence was recorded in any case. While intravascular embolotherapy is the treatment of choice for high-flow fistulae, stereotactic radiosurgery may be the elective treatment for low-flow CCF.