Treatment of 54 traumatic carotid-cavernous fistulas

Abstract

A series of 54 traumatic carotid-cavernous fistulas has been treated with detachable balloon catheters. The balloon was introduced through one of three different approaches: the endarterial route; the venous route through the jugular vein, the inferior petrosal sinus, and the cavernous sinus; or surgical exposure of the cavernous sinus; with occlusion of the fistula by a detachable balloon directly positioned in the cavernous sinus. Full follow-up review demonstrated that the carotid blood flow was preserved in 59% of cases. The most frequent complication was a transient oculomotor nerve palsy, which occurred in 20% of cases. In three cases where both the fistula and the carotid artery were originally occluded by the balloon, the superior portion of the fistula was later found not to be completely occluded, and these patients had intracranial ligation of the supraclinoid portion of the carotid artery. Three patients had hemiparesis, transient in two cases and permanent in the other. The results show that the fistula was totally occluded in 53 cases; in the one exception the patient became asymptomatic but had a minimal angiographic leak.

Fístula carótido-cavernosa com epistaxe letal: relato de caso

“…A localização da fístula é em sua maioria no segmento horizontal da ACI intra-cavernosa, com 41% dos casos, e em 29% dos casos na junção dos segmentos horizontal e ascendente posterior. A junção da porção horizontal com a ascendente anterior responde a 9% dos casos e apenas 2% ocorre no segmento ascendente anterior 6 .…”

“…Estas são lesões de alto fluxo e alta pressão e possuem incidência baixa de hemorragias. Fístulas carótido-cavernosas (FCCs) são um tipo específico de fístula arteriovenosa e representam comunicações anormais entre a artéria carótida interna (ACI) e o seio cavernoso, surgindo de modo incomum, porém, não raro [1][2][3][4][5][6][7][8] . Inicialmente podemos dividir todas as FCCs em espontâneas e pós-traumáticas.…”

Traumatic Middle Meningeal Artery and Fistula Formation with the Cavernous Sinus and a Review of the Literature on Endovascular Management of Traumatic Carotid Cavernous Fistulas

“…Third and sixth nerve palsy after balloon embolization has also been observed. Debrun et al [20] reported a 20% incidence of transient oculomotor nerve palsy, which is usually combined to sixth cranial nerve dysfunction.…”

Embolización de fístula carótido cavernosa indirecta a través de la vena oftálmica superior

“…La mayoría de las FCC directas pueden cerrarse mediante tratamiento endovascular, generalmente por vía arterial mediante coils o balones 8,17 , aunque también se han obtenido buenos resultados por vía venosa 13 . El tratamiento de las FCC indirectas o durales es más complicado, siendo la vía venosa de elección para la mayoría de los autores 1,7,12,18,21,26 .…”