Endovascular approach to treatment of indirect carotico-cavernous fistulae

The purpose of the study was to assess the cure rate in patients with indir ect carotico-cavernous fistula (CCF) treated by transvenous embolisation vi a the inferior petrosal sinus (IPS) pathway or the superior ophthalmic vein (SOV). Twelve fistulae in 11 patients were treated by transvenous embolisa tion, eight patients via the IFS and four fistulae in three patients via th e SOV. Angiographic cure was defined as complete obliteration of the fistul a and clinical cure as total resolution of signs and symptoms. Complete cur e was achieved in eight patients with nine fistulae embolised transvenously . Five fistulae were approached via the IFS and four via the SOV. Our prefe rred method for treatment of indirect CCF is the transvenous route. The IFS approach is technically easier and has fewer potential risks than the SOV approach. However, if the IFS is not patent the SOV can provide good altern ative access to the cavernous sinus.