Endo Vascular Embolotherapy Of Traumatic Carotid Cavernous Fistula (with A Case Report)

Purpose:To evaluate the endovascular embolotherapy for traumatic carotid cavernous fistula (TCCF), to discuss the clinical features of TCCF manifested as delayed intracranial hemorrhage.Methods:We collected and retrospectively analyzed the clinical data of patients who suffered TCCF which were treated by surgical operation in neurosurgery department of Qilu hospital of Shandong University ranging from Nov2003to Feb2013. Descriptive statistics were used to analyze the data including gender, age, main symptoms, surgical techniques and so on based on the clinical records. And we emphasized the clinical features and treatment on a case of TCCF manifested as delayed intracranial hemorrhage.Results:The patients in this article totally were45, including33males and12females aged17-70years old, and the ratio was2.75:1. The symptom of bruit took account of68.9%, pulsating exophthalmos and conjunctival chemosis were80.0%respectively. Others were ptosis (24.4%), ocular movement dysfunction (35.6%), progressive hypopsia and diplopia (42.2%), dizziness or headache (2.2%), and intracranial hemorrhage (2.2%). One of the45patients in this group presented with delayed intracranial hemorrhage which was revealed by digital subtraction angiography (DSA) that drained by cortical veins was responsible. There’s no more than20cases reported after literature searches. Transarterial embolotherapy for TCCF is the first choice, and the detachable balloon is the optimal material. While for some complicated TCCFs, transvenous approach or combination of both transarterial and transvenous approach is still needed as well as coil, liquid embolic material (for example, Onyx18) and covered stent and so forth. In the group of45TCCF patients,33patients were cured by detachable balloon via transarterial approach,2patients were cured by coil only,3patients were cured by balloon-assisted embolization with Onyx18,1patient was cured by coil and Onyx18,1patient was cured by Jostent covered stent,2patients were cured by balloon-assisted embolization with coil and Onyx18via transarterial and transvenous approach,1case occluded the internal carotid artery, the other2patients gave up surgical treatment for some individual reasons. All of the patients succeeded in the first operation and received satisfactory result.Conclusions:Except the classic triad of bruit, pulsating exophthalmos and conjunctival chemosis, TCCF can also present as some atypical manifestations such as delayed intracranial hemorrhage. Transarterial detachable balloon embolization is still the first choice for TCCF, but for some complicated cases, combination of transarterial and transvenous approach with the help of balloon, coil and Onyx18is an effective treatment.