RADIOTHERAPY OF DURAL CAROTID-CAVERNOUS SINUS FISTULAS

Dural carotid-cavernous sinus fistulas(CCF) are complicated and diffic ult to treat, Nine patients with dural CCF were treated with 10-MV X-r ay from a linear accelerator to the sella region. Angiographically, fo ur patients had bilateral dural CCF feeding from bilateral external an d infernal carotid arteries, three patients had unilateral dural CCF f eeding from bilateral external and internal carotid arteries. Two pati ents had unilateral dural CCF feeding from ipsilateral external and in ternal carotid arteries, The total dose of radiation was in the range 40-60 Gy, Complete disappearance of clinical signs and symptoms was di scerned in four patients, of whom subsequent angiography of two patien ts showed complete regression of dural CCF. One patient developed neov ascular glaucoma, and repeated angiography showed residual dural CCF. After an additional 20 Gy irradiation, disappearance of dural CCF was shown on angiography. The other four patients had improved clinical sy mptoms and signs within five months of radiotherapy, When surgery or e mbolization cannot successfully close a dural carotid-cavernous sinus fistula, irradiation to the sellar region may be considered. No advers e effects were noted.