Stereotactic gamma surgery combined with endovascular surgery for treatment of a spontaneous carotid cavernous sinus fistula

A Barrow type D carotid cavernous sinus fistula (CCF) with varices proved u namenable to endovascular surgery. Follow-up angiography showed a persisten t CCF fed by a recurrent meningeal branching of the ophthalmic artery divis ion with drainage into the ophthalmic vein, resulting in a secondary glauco ma and central retinal thrombosis. Stereotactic gamma surgery was successfu lly performed, and aggravation of the visual symptoms was prevented. The CC F disappeared and intraocular pressure normalized one month after the radio surgery. Stereotactic radiosurgery is thus an appropriate treatment for cav ernous sinus dural arteriovenous fistulas resistant to endovascular treatme nt, especially with small, slow flow target residual fistulas.