[Dural carotid-cavernous fistulas: progression in therapeutic management from 1989 to 2004. A report of ten cases].
BACKGROUND
Dural carotid-cavernous fistulas are rare and require multidisciplinary management. Today there is no consensus on treatment, even though embolization is currently the first-line treatment. We present the cases of ten patients with a dural carotid-cavernous fistula diagnosed between 1989 and 2004 in order to compare the therapeutic choices used to treat dural carotid-cavernous fistulas in the late 1980s and mid-1990s to the therapeutic strategy currently favored.


METHODS
The ten patients, with a mean age of 65.9 years, were seven women and three men. They had an ophthalmologic examination and the diagnosis was angiographically confirmed. Treatments were either noninvasive (such as decoagulation and/or carotid-jugular or ocular compression) or embolization. A combination of these different treatment modalities was provided for several patients.


RESULTS
The main symptoms were arterialized conjunctival veins, proptosis, diminished visual acuity, chemosis, elevated intraocular pressure, and diplopia. Of the seven patients who only had noninvasive treatment (embolization not possible), three remained stable, three showed partial improvement, and the last one was clinically cured. As for the three patients treated with embolization (prior or not), this treatment led to a dramatic clinical improvement for one patient, a clinical cure for the second, and a complete cure in the remaining patient.


CONCLUSIONS
Prior embolization when possible appears to be an effective and safe treatment for dural carotid-cavernous fistulas. Nonetheless, noninvasive treatment options, particularly compressions, remain an important therapeutic alternative.
Moreau-Gaudry
V Vinh
VV
Service d'ophtalmologie, CHU, Grenoble. vvinhmoreaugaudry@chu-grenoble.fr
Lefournier
V
V
Descour
F
F
Bessou
P
P
Vasdev
A
A
Chiquet
C
C
Romanet
J-P
JP
D000368:Aged; D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies