title: Direct intracavernous obliteration of high-flow carotid-cavernous fistulas.
abstract: Four cases of high-flow carotid-cavernous sinus fistula (CCF), three of them posttraumatic and one spontaneous, have been treated by a direct surgical approach to the cavernous sinus. The CCF's were obliterated by the introduction into the cavernous sinus of muscle fragments and/or fibrin sealant. In the three cases with a preoperatively patent internal carotid artery (ICA), the CCF was occluded and the ICA flow preserved. One of these also had a posttraumatic false aneurysm that enclosed the two avulsed ends of a transected intracavernous ICA. This was treated by cervical ICA ligation following resolution of the CCF. A fourth patient, who had previously undergone an unsuccessful ICA trapping procedure elsewhere, also obtained a good result. The case histories and the surgical technique are presented. Direct intracavernous obliteration with muscle fragments and fibrin sealant fulfills the criteria for treatment of high-flow CCF's: occlusion of the arteriovenous fistula and preservation of the ICA circulation. While this surgical technique is a therapeutic option in some cases, it appears to have precise indications in others.
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery*; D002426:Cavernous Sinus / Q000601:surgery*; D005260:Female; D005337:Fibrin / Q000627:therapeutic use; D015718:Fibrin Tissue Adhesive; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D015718:Fibrin Tissue Adhesive; D005337:Fibrin