Spontaneous Resolution of Post-Traumatic Direct Carotid-Cavernous Fistula

Abstract

Post-traumatic carotid-cavernous fistulas are due to a tear in the wall of the cavernous carotid artery, leading to shunting of blood into the cavernous sinus. These are generally high-flow fistula and rarely resolve spontaneously. Most cases require endovascular embolization. We report a case of Barrow type A carotid-cavernous fistula which resolved spontaneously.

Hemicranial Cough-Induced Headache as a First Symptom of a Carotid-Cavernous Fistula-Case Report

“…Type B are the dural shunts of the meningeal branches of the internal carotid artery with the cavernous sinus. Type C is a dural shunt of the meningeal branches of the external carotid artery with a cavernous sinus, and type D is a combination of types B and C. Types B, C, and D are characterized by low flow [1,3,5,6,10]. Our patient, had CCF type A2 caused by an aneurysm rupture that most likely occurred with a cough.…”

“…Spontaneous thrombosis of type A fistula due to direct communication, and rapid flow happens very rarely [5]. However, it has also been described in multiple cases [5,10,13]. Uchino A. and associates provide two potential explanations for why their patient experienced spontaneous CCF thrombosis after a failed balloon-occluded transarterial chemoembolization.…”

“…Given that endovascular therapy has proven to be the most successful therapy with very few complications [3,13], our patient was immediately referred to a neurosurgeon for artificial embolization, which, due to spontaneous thrombosis of the fistula, was not performed. Spontaneous thrombosis of type A fistula due to direct communication, and rapid flow happens very rarely [5]. However, it has also been described in multiple cases [5,10,13].…”

“…Carotid-cavernous fistula (CCF) is a pathological communication of the carotid arteries or their branches with the cavernous sinus [1][2][3][4][5]. In relation to cause, they are divided into traumatic, spontaneous, and iatrogenic.…”

“…Drainage is usually mixed [1]. The type of drainage conditions the clinical picture [3,5,6]. If there is an anterior drainage, the clinical picture is mainly accompanied by ocular symptomatology ranging from pulsating exophthalmos, conjunctival chemosis, thickening and tortuosity of the scleral vessels, signs of elevated intraocular pressure, nystagmus, impaired mobility of the eye to ophthalmoplegia, diplopia, and the decrease in visual acuity, while posterior drainage is characterized by an impression of a humming noise in the head.…”