OBJECTIVE: To save the patency of the internal carotid artery (ICA) during the treatment of carotid cavernous fistulae or cavernous sinus dural @entity2758 , direct surgery of the cavernous sinus after failure of endovascular treatment was attempted in this study. METHODS: A total of 78 @entity1 with carotid cavernous fistulae or cavernous sinus dural @entity2758 were treated. Obliteration of the fistulous rent and preservation of the ICA were the therapeutic goals. All @entity1 , except one in whom @entity548 occurred, received endovascular treatment as the first treatment. In 18 (23.4%) of these 77 @entity1 , it was not possible to obliterate the fistulous rents without sacrificing the ICAs. The 18 @entity1 and the 1 @entity1 with @entity548 underwent direct surgery to open the cavernous sinus. RESULTS: Various methods, including suturing or clipping the fistulae, sealing the fistulae with fascia and acrylate glue, and packing the cavernous sinus were applied. In each of three complicated cases, the cavernous segment of the ICA was trapped and an intracranial bypass from the petrous segment to the supraclinoid segment was performed. There was nor mortality, and the most common morbidity was transient @entity2895 , which occurred in eight @entity1 . Follow-up angiography revealed that the ICAs or bypass grafts were thrombosed in 5 of the 19 @entity1 who had undergone surgery. CONCLUSION: In this series, the overall ICA patency rate of @entity1 who underwent embolization and surgery was 94%, and the obliteration rate of the fistulae was 100%. Direct surgery of the cavernous sinus as a complimentary treatment of embolization can increase the preservation rate of the ICA.

Direct surgery of carotid cavernous fistulae and dural XXXX of the cavernous sinus.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity2758 :: ('MESH:D001165', 'Disease') :: ['arteriovenous malformations'] @entity548 :: ('MESH:D006470', 'Disease') :: ['acute bleeding'] @entity2895 :: ('MESH:D015840', 'Disease') :: ['oculomotor palsy']
@entity2758 :: (MESH:D001165,Disease) :: ['arteriovenous malformations']
