Hypoxic ocular sequelae of carotid-cavernous fistulae. Study of the caues of visual failure before and after neurosurgical treatment in a series of 25 cases.

Abstract

The incidence of visual failure with carotid-cavernous fistula is high. It was impaired in 89 per cent. of the cases studied by de Schweinitz and Holloway (I908) and in 73 per cent. of those studied by Sattler (I920). The latter recorded blindness or near blindness in almost half of his patients. Treatment has reflected a clinical preoccupation with elimina- tion of the bruit and reduction of the proptosis, and modern methods have become increasingly proficient at obtaining this by more extensive surgery (Dandy, I935; Echols and Jackson, I959; Hamby, I966). However, in this condition, where the threat to life is small, preservation of vision becomes the major aim of therapy. Realisation of this goal has been lacking, though the ocular and cerebral hazards of surgery have recently been stressed by neurosurgeons (Walker and Allegre, I956; Stern, Brown, and Alksne, I967).