The authors reported a case of spontaneous
carotid-cavernous sinus fistula fed by meningohypophyseal trunk of the internal carotid artery, that completely disappeared following
cobalt 60 irradiation to the region of
fistula (27 days; total dose, 4,100 rad). A 65-year-old man was admitted to our hospital on May 25, 1982, with a two-week history of progressive prominence of the left eye,
diplopia on left lateral gaze, and continuous intracranial bruit. He first noted redness of the left eye without apparent cause such as
head trauma. On admission, slight nonpulsative
exophthalmos, periorbital
edema, chemosis, and
venous congestion of the conjunctiva of the left eye were noted. The pupils were reactive and equal in size, and the left abducent nerve
palsy was observed. Fundoscopic examination disclosed to be normal. No bruit was heard over the left orbital region. Left carotid angiography on May 28 demonstrated dural internal
carotid-cavernous sinus fistula fed by meningohypophyseal trunk, and drained into superior and inferior ophthalmic veins and basilar venous plexus. Though the patient was treated only conservatively, symptoms became worse to decrease visual acuity. On July 14, we started
cobalt 60 irradiation to the region of
fistula (27 days; total dose 4,100 rad). Symptoms gradually improved about halfway through irradiation. After completion of irradiation, almost complete improvement of visual and ocular symptoms was observed except the left abducent nerve
palsy. Repeated angiography on Aug. 20 revealed complete disappearance of
fistula. Three months
after treatment, no recurrence of symptoms was observed and the abducent nerve
palsy persisted without improvement.(ABSTRACT TRUNCATED AT 250 WORDS)