The Endovascular Treatment of Traumatic Cavernous Sinus Arteriovenous Fistulas: A Single-center Experience

Abstract

Objective:The treatment for traumatic carotid cavernous fistula (TCCF) that occurred after head trauma is evaluated based on our experience. Methods:The clinical characteristics, treatments, and outcomes were retrospectively evaluated in six patients with TCCF that we treated between April 2012 and July 2015.Results: The mean age of the patients, consisting of five males and one female, was 45.5 ± 16.8 years. The head trauma was acute subdural hematoma (ASDH) in one patient, acute epidural hematoma (AEDH) in one, brain contusion in two patients, and skull fracture in three patients. The patients exhibited bulbar conjunctival congestion, exophthalmos, and disturbance of ocular movement mean of 2.2 ± 1.8 months (2 days and 5 months) after injury, and the one patient who suffered rupture of pseudoaneurysm showed arterial nasal bleeding. The presence of fistula in the cavernous portion of the internal carotid artery was confirmed by cerebral angiography, and the mean maximum diameter of the fistula, measured by 3D DSA, was 9.6 ± 3.2 mm (2.4-19.9 mm). Endovascular procedures were completed in all patients, but among those with a large fistula, parent artery occlusion (PAO) was selected for three patients with ischemic tolerance, and transvenous embolization (TVE) of the cavernous sinus was selected for two patients with no tolerance. In a patient with a small and simple fistula, percutaneous transluminal angioplasty (PTA) was performed with covered stent placement.The shunt disappeared, and neurological symptoms were resolved within 1 month, in all patients. The postoperative course during a mean follow-up period of 21.0 ± 13.5 months was uneventful without recurrence. Conclusion:Satisfactory outcomes could be achieved by endovascular treatment for TCCF by selecting an appropriate method for each patient.