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. 2020 Oct 21:13:917-925.
doi: 10.2147/IJGM.S273603. eCollection 2020.

Neuro-Endovascular Intervention in Traumatic Carotico-Cavernous Fistulae: A Single-Center Experience

Muhamad Thohar Arifin  1 , Mohammad Ali Akbar  1 , Widianto Illyasa  1 , Krisna Tsaniadi Prihastomo  1
Affiliations

Neuro-Endovascular Intervention in Traumatic Carotico-Cavernous Fistulae: A Single-Center Experience

Muhamad Thohar Arifin et al. Int J Gen Med. .

Abstract

Introduction: The aim of this research was to describe a single-center practical experience in the management of traumatic carotid cavernous fistula (CCF).

Methods: There were a total of 31 patients between January 2005 and December 2019 with post-traumatic carotid cavernous sinus fistula (tCCF) who underwent treatment. We classified them into 2 types according to the flow of the CCF: patients with high flow CCF and patients with low flow CCF.

Results: Angiography revealed the high flow types on 21 patients (67.7%), the mean of patients ages are 31.5 years. Onyx embolization was performed in 1 patient (4.76%), transarterial balloon embolization was carried out in 10 patients (47.61%), transarterial coiling in 3 (14.28%) patients while 5 (28.8%) patients underwent transvenous routes to insert the coil and 2 patients (9.52%) were treated conservatively. Complete occlusion was achieved on all patients with coiling whereas the other treatment experiences the reducing flow of the fistula. We obtained 10 patients (32.2%) with a mean of 40.3 years as low flow type CCF. The patients with the low flow type mostly treated conservatively, because their symptoms were acceptable and intermittent.

Conclusion: The ballooning currently became the more affordable treatment in our center. Balloon embolization was recommended for medium- and large-size fistula. The coils should be recommended for small-size fistula. In some cases occlusion of the fistula cannot be obtained using the detachable balloon, a coil can be used to occlude the cavernous sinus via trans arterial or trans venous access. If the fistula failed to be treated in traditional ways using balloons or coils, occlusion of the parent vessels could be another option.

Keywords: angiography; carotid cavernous sinus fistula; embolization; transarterial; transvenous; trauma.

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Conflict of interest statement

The authors report no conflicts of interest for this work.

Figures

Figure 1
Figure 1
Sign exophthalmos, chemosis.
Figure 2
Figure 2
Angiography showed CCF, fistula at C5–C4 internal carotid artery segment. The drainage of the vein was through the cavernous sinus, the upper or lower petrosal sinus to the sigmoid sinus, and via the variceal upper petrosal vein to the deep Galenic system.
Figure 3
Figure 3
Trans arterial Gold Ballon occlusion.
Figure 4
Figure 4
A 7 F angiography catheter, Trans femoral venous entry, was located just below the jugular foramen. Then a microcatheter was directed to the cavernous sinus through jugular bulb and inferior petrosal sinus. The tip then was inserted in the upper orbital vein and the coils were removed in it and at the fistula to minimize shunt flow.
Figure 5
Figure 5
Post coil embolization.
Figure 6
Figure 6
Transarterial coil embolization. (Upper left and upper right) Showed the fistula come from ICA segment C3–4. (Lower left and lower right) revealed no more extravasation contrast on cavernous sinus after filled with detachable coils.
See this image and copyright information in PMC

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