Revisiting Parkinson: After six decades, his triangle remains useful

BACKGROUND: The welcome advent and subsequent development of interventional neuroradiology led to an important paradigm shift in the management of many cerebrovascular diseases. This paradigm shift is especially true for carotid cavernous fistula and, for some time now, endovascular techniques are the mainstay approach for these lesions. The neurosurgical intervention should be adopted when the endovascular treatment is not practicable. CASE DESCRIPTION: We present the surgical solution adopted to treat a patient with an indirect carotid cavernous fistula (CCF), with quickly progressive symptoms, in which it was not possible to treat using the currently standardized endovascular technique. A pretemporal craniotomy with peeling of the dura mater at the middle fossa and exposure of Parkinson’s triangle on the lateral wall of the cavernous sinus was performed. Fibrin glue was injected by puncture of the lateral wall of the cavernous sinus for direct thrombosis of this sinus and the superior ophthalmic vein. CONCLUSION: In the now far 60s, Parkinson already treated patients with CCF effectively and elegantly through the lateral wall of the cavernous sinus. Revisiting techniques from the past, associating them with the supplies widely available today, can sometimes be the solution to some especially challenging cases that we face in our profession.