Dural carotid cavernous fistulas: role of conventional radiation therapy--long-term results with irradiation, embolization, or both.

PURPOSE: To evaluate the long-term results of irradiation alone or of embolization with or without irradiation in patients with dural carotid cavernous fistulas (DCCFs). MATERIALS AND METHODS: Between 1984 and 1996, symptomatic DCCFs in 26 patients were treated by using irradiation alone (protocol 1, n = 12) before April 1988 and by using embolization as an initial treatment (protocol 2, n = 14) during and after April 1988. When angiography showed no improvement after embolization, irradiation was added (n = 6). On the basis of drainage flow speed, DCCFs were classified as fast, medium, or slow. RESULTS: With irradiation alone, all six patients with slow- to medium-type DCCFs had cure with a mean follow-up of 62 months. Four of six patients with fast-type DCCFs had cure or improvement, but the remaining two had no change. In the embolization group, irradiation was added in six patients with fast-type DCCFs. With a mean follow-up of 24 months, four of the six patients had cures, one had improvement, and one had no clinical change. Those who underwent protocol 2 had cures significantly earlier than those who underwent protocol 1 (P < .05). CONCLUSION: Conventional radiation therapy resulted in cure of DCCFs in nine (75%) of the 12 patients an in improvement of signs and symptoms in one (8%). Fast-type DCCFs may not always be improved. Radiation therapy may be useful in DCCFs after embolization.