Management of spontaneous carotid-cavernous fistulae.

Fifteen cases of spontaneous carotid-cavernous fistulae, including 4 patients with spontaneous cure and 8 treated with electrothrombosis, are reviewed. Careful angiographic observation will verify closure of the fistula. Aggravation of visual and/or ocular symptoms can also develop with spontaneous carotid-cavernous fistulae. Recurrence of symptoms and development of collaterals were noted, especially after carotid ligation or embolization of the external carotid artery. Electrothrombosis successfully closed the fistulae in 7 patients. The internal carotid artery was occluded in 1 patient who had a preoperative carotid stenosis at the cervical level. The ability to differentiate angiographically between single and multiple fistulae provides a new possibility that spontaneous carotid-cavernous fistulae can be treated with detachable balloon catheters.