Flow diverter stents for pediatric traumatic carotid cavernous fistula: a case report and literature review

Abstract

A 10-year-old, male patient with a head injury caused by a fall presented with chemosis, exophthalmos, right orbital bruit, and intracranial venous reflux, based on which posttraumatic carotid cavernous fistula (CCF) was diagnosed. Coil embolization was semi-urgently performed for the dangerous venous drainage. After the treatment, right abducens nerve palsy newly appeared. To treat the neurological symptoms and preserve the parent artery, curative endovascular treatment using a pipeline embolization device (PED) with coil embolization was performed after starting dual antiplatelet therapy (DAPT). The CCF and abducens nerve palsy finally resolved, and the internal carotid artery (ICA) was remodeled. Use of the PED with adjunctive coil embolization was effective and safe in the present case of pediatric traumatic direct CCF.

Challenging Management of an Acute Traumatic Carotid-Cavernous Fistula in a 2-Year-Old Child with Literature Review

“…Traumatic carotid-cavernous fistula (TCCF) is a very rare occurrence in the pediatric population, with a frequency of 0.2 to 0.3% after craniofacial trauma, and increasing up to 4% following skull base fractures. 3 5 6 Despite its rare occurrence, TCCF reported in children can be accompanied by drastic consequences such as intracerebral hemorrhage, de novo aneurysm formation, and irreversible vision loss or ophthalmoplegia. 6 7 Due to the high vulnerability of pediatric patients, the TCCF's neurological sequelae are associated with higher burden of visual disability and potential mortality in this population.…”