Dural carotid-cavernous fistulas: epidemiology, clinical presentation, and management.

Dural arteriovenous fistulas of the cavernous sinus are no longer difficult to diagnose or treat. Specific ocular manifestations allow these fistulas to be diagnosed clinically. Noninvasive imaging techniques can be used to confirm the diagnosis. The most common treatment is endovascular occlusion of the lesion via a transarterial or transvenous route. Manual compression of the ipsilateral internal carotid artery in the neck or radiation therapy is appropriate in selected cases. Regardless of the treatment used, the fistula can be closed completely in most cases, resulting in restoration of normal orbital and intracranial blood flow and resolution of visual deficits.