Walsh & Hoyt: Treatment

Various investigators have advocated direct surgery, conventional radiation therapy, stereotactic radiosurgery, or intermittent self-compression of the affected internal carotid artery for treatment of dural CCF. Although these treatments may be appropriate for selected patients, endovascular embolization is the optimum treatment for those lesions that produce progressive or unacceptable symptoms and signs including visual loss, diplopia, intolerable bruit, severe proptosis, and, most importantly, cortical venous drainage. A number of synthetic and natural materials can be used for embolization, including absorbable gelatin (Gelfoam), Silastic, platinumcoils, low-viscosity silicone rubber, autogenous clot, muscle or dura, tetradecyl sulfate (a sclerosing agent), polyvinyl alcohol particles (lvalon), ethanol, oxidized cellulose (Oxycel), and isobutyl-2-cyanoacrylate glue (Bucrylate).