Long-term observations in cases with spontaneous carotid-cavernous fistulas.

Twenty cases with spontaneous carotid-cavernous fistulas were followed up for periods ranging between 9 months and 9 years 8 months. In five cases, a temporary reappearance of symptoms was noted within 6 months after their regression. A complete regression of symptoms without reappearance for more than 6 months (between 6 months and 6 years 10 months) was noted in 18 cases, and a marked improvement was noted in one case. The regression of symptoms was usually delayed in patients less than 60 years old, in cases in which the symptoms developed slowly, and cases with three draining veins. According to these observations, noninvasive treatment is basically recommended in cases with spontaneous carotid-cavernous fistulas.