Direct Surgical Approach of the Spontaneous Carotid Cavernous Fistula

We report a case of spontaneous carotid cavernous fistula(CCF) showing low flow shunt, which was successfully occluded in the fistular site of CCF by direct surgical approach via anteromedial, paramedial and Parkinson's triangle intradurally through pterional subte mporal petrosal route extradurally after intermitten temporary clipping of internal corotid artery(ICA) in petrosal portion and proximal to the ophthalmic artery without hypotension, hypothermia, extracorporial circulation, or cardiac arrest.