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The intravascular use of the rapidly polymerizing acrylic compound isobutyl 2-cyanoacrylate in four patients with carotid-cavernous fistulas is described. The monomer was injected into the cavernous sinus at craniotomy after the intraoperative angiographic identification of the fistula site and the origin of its venous drainage. All patients had postoperative angiographic documentation of fistula closure and confirmed carotid artery patency. There was no operative mortality or permanent neurological morbidity. Two patients (50%) suffered transient dysfunction in the immediate postoperative period of one of the cranial nerves that transit the cavernous sinus.

The intravascular use of the rapidly polymerizing acrylic compound, isobutyl 2-cyanoacrylate (IBC), in 10 patients with intracranial arteriovenous malformations (AVMs) is described. The monomer was introduced into each malformation at craniotomy using angiographic control and microvascular dissection technique to identify, isolate, and inject the major components of each vascular lesion while attempting to preserve normal arterial circulation. Postoperative angiography was used routinely to evaluate the results of IBC embolization. Four patients underwent the injection and immediate surgical excision of an intracranial AVM, and 6 underwent injection alone; 3 of the latter had residual malformation demonstrated on postoperative angiography, and 1 of these patients had the remnants of her malformation occluded by a second embolic procedure. There was no operative mortality nor permanent neurological morbidity. Three patients suffered transient neurological dysfunction in the immediate postoperative period.

We report a new treatment for carotid-cavernous fistula. Using a flow-guided, balloon-tipped microcatheter, we catheterize the fistula itself, verify balloon entry into the fistula with fluoroscopy and x-ray films, and then infuse the tissue adhesive isobutyl-2-cyanoacrylate with careful fluoroscopic control. Three patients have had their fistulas occluded, with preservation of flow through the internal carotid artery. This balloon microcatheter allows the radiologist to perform a reversible test occlusion. All three patients had neurological changes during or after the procedure, and in one we inadvertently occluded several distal middle cerebral artery branches without permanent neurological deficit. No patient became blind or developed 3rd, 4th, or 6th nerve palsy from the treatment. This technique seems to have promise as another method for the obliteration of carotid-cavernous fistula.