Embolisation of dural carotid cavernous sinus fistulas via a vein of the sylvian fissure in two patients

Background. Dural carotid sinus cavernous fistulas account for about 12% of intracranial arteriovenous fistulas. These dynamic shunts are dilemmas not only for the clinical diagnosis but also for the management of ocular comp lications and in the application of diagnostic and therapeutic techniques. The traditional therapy is transarterial embolisation by an interventional neuroradiologist. We report on the management of two fistulas where the cla ssical therapeutic methods were not possible or failed. Patients and methods. Two patients underwent an osteoplastic pterional cran iotomy with cannulation of a vein of the sylvian fissure and controlled emb olisation of the fistula with polyvinyl alcohol particles. Results. Successful closure of both arteriovenous shunts was achieved on an giography with normalisation of clinical symptoms. As a severe complication one patient suffered from a stroke after the postoperative angiography. Conclusions. Arteriovenous fistulas not approachable by traditional therape utic methods, can be embolised effectively via a superficial vein of the sy lvian fissure. This surgical route should only be considered if other thera peutic ways fail or seem impossible.