Treatment of direct carotid-cavernous fistulas with detachable balloons.

Experience with transarterial treatment of 14 direct carotid-cavernous fistulas using the Debrun technique with detachable balloons manually tied to the catheter is reported. Ten of the fistulas were occluded by balloons with concomitant occlusion of the internal carotid in one case. Another fistula closed spontaneously in connection with the embolization procedure. Three fistulas were treated with surgical trapping after recurrence. The transvenous approach was attempted in three cases but failed. Four complications occurred, two with clinical consequences as the patients developed neurologic deficits. Except in four cases with persistent or slowly regressing orbital palsies all signs and symptoms of the fistula disappeared after successful occlusion. The use of detachable balloons for selective occlusion is in experienced hands a rather safe and simple method with good results. Large fistulas offer most problems, and to avoid progression in fistula size the treatment should be undertaken as soon as possible after diagnosis.