[Goniotrepanation combined with sinus surgery as a transitional measure in spontaneous carotid artery-cavernous sinus fistulas].

Two patients with spontaneous, angiographically proven fistulas showed progressive ocular symptoms which precluded waiting for spontaneous occlusion of the fistulas. On the other hand, endovascular therapy of the carotid-cavernous fistulas was not possible because the arterial supply of the fistulas came from both internal carotids. Therefore filtering surgery was performed in the affected eyes. Postoperatively, intraocular pressure decreased to normal values in both patients and the symptoms resolved. The visual acuity increased in one patient and remained the same in the other. In conclusion, filtering surgery is an important therapeutic tool to preserve visual function in eyes with carotid-cavernous fistulas that display progressive ocular symptoms but cannot be treated by embolization.