Improved localization of carotid cavernous fistula during angiography.

The use of detachable balloons for treating carotid cavernous sinus fistulas is increasing [1-6]. Its success requires exact localization of the fistula site, which may not always be possible with standard angiographic techniques [7]. Rapid opacification of the venous side of the fistula is apt to obscure the point of arteriovenous communication before it is precisely delineated . Rapid filming (four or more films per second), special projections, and subtraction technique are useful adjuncts to standard technique but may not be adequate. Several carotid occlusive techniques for improving the angiographic localization of carotid cavernous fistulas have been described. Huber [8] used ipsilateral carotid compression during vertebral artery injection to fill the fistul a retrogradely via the posterior communicating artery. The fistula is often well localized by this method, but it requires a patent posterior communicating artery. Cares et al. [9] used a Prolo