Type D dural carotid-cavernous fistula. Results of combined treatment with irradiation and particulate embolization.
OBJECTIVE
To assess the efficacy of irradiation combined with particulate embolization for treating type D dural carotid-cavernous fistulas, supplied by the meningeal branches of both external (ECA) and internal carotid arteries.


METHODS
Nine patients were treated by particulate embolization via the ECA branches, followed by radiation therapy with doses of 30 Gy. One of these patients with recurrent symptoms received an additional 30 Gy one year after initial treatment, making a total dose of 60 Gy.


RESULTS
In all cases, symptoms were improved immediately after the particulate embolizations. In 8 cases, complete resolution of symptoms were obtained in 4-19 months and an average of 8 months after treatment. In one case, chemosis was markedly improved and persisted minimally 41 months later.


CONCLUSIONS
Particulate embolization is effective for immediate symptomatic improvement, and complete resolution of symptoms can usually be achieved by subsequent radiation therapy.
Hasuo
K
K
Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Mizushima
A
A
Matsumoto
S
S
Uchino
A
A
Uehara
S
S
Miyoshi
M
M
Mihara
F
F
Ohmagari
J
J
Ohnishi
Y
Y
Masuda
K
K
D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000532:radiotherapy / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000532:radiotherapy / Q000628:therapy*; D002342:Carotid Artery, External; D002343:Carotid Artery, Internal; D002426:Cavernous Sinus; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011142:Polyvinyl Alcohol