title: Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression.
abstract: OBJECTIVE
  External manual carotid compression is a noninvasive method to treat cavernous sinus (CS) dural arteriovenous fistulae (DAVF). We studied a group of patients with CS-DAVF to identify what factors made complete resolution of their clinical symptoms and closure of the DAVF on magnetic resonance angiography (MRA) by compression therapy possible.
  
  
  METHODS
  We treated 23 patients with CS-DAVF without cortical venous drainage or a recent decline in visual acuity by compression therapy. All were followed up by magnetic resonance angiography at 1, 3, 6, and 12 months after treatment and the characteristics of the imaging findings, their neurological symptoms, and the patterns of symptom improvement were examined.
  
  
  RESULTS
  In Group A (n = 8), complete resolution was achieved by manual carotid compression. In the other 15 patients (Group B), complete resolution was not obtained. Group B manifested significantly higher ocular pressure and a significantly longer interval between symptom onset and compression treatment. In Group A, venous drainage was via the superior orbital vein with or without involvement of the inferior petrosal sinus. Closure of the CS-DAVF occurred within 4.1 months after the start of treatment. In three patients, symptom improvement progressed steadily and gradually. The other five patients with complete resolution experienced transient worsening of their symptoms at 2 to 4 months after the start of treatment and symptom resolution occurred within 4 to 7 months.
  
  
  CONCLUSIONS
  We identified lower ocular pressure, a shorter interval between symptom onset and compression treatment, and venous drainage solely via the superior orbital vein without involvement of the inferior petrosal sinus as the factors in our CS-DAVF patients that made complete resolution by manual carotid compression possible.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. ykai@kaiju.medic.kumamoto-u.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kai
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Yano
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kuratsu
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000502:physiology; D002426:Cavernous Sinus / Q000000981:diagnostic imaging* / Q000473:pathology; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D019245:Compressive Strength / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods; D011859:Radiography; D016896:Treatment Outcome