Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein.

From 1974-1986, 152 patients with carotid cavernous sinus fistulae (CCF) have been evaluated. Progressive closure of both dural and direct types of CCF have been noted utilizing intermittent external manual compression of the cervical carotid artery and jugular vein. In a group of 71 patients in whom this treatment was attempted, we have observed that 7 of 23 patients (30%) with dural CCF, and 8 of 48 patients (17%) with direct CCF had complete closure of their fistulae with no recurrence either clinically or at angiography done one year later. Closure occurred at varying times, from several minutes to 6 months (mean 41 days) following compression therapy. In those patients with CCF without rapidly progressive visual deterioration, cerebral ischemia, or other complicating factors, we recommend this technique with serial clinical follow-up and angiography before more definitive therapy is employed.