Endovascular Treatment for Type A Carotid Cavernous Fistulas with Detachable Coils

Abstract

Objective: Carotid cavernous fistulae (CCF) after head traumas are abnormal communications between the internal carotid artery and venous compartments of the cavernous sinus. Fistulae are uncommon but well-documented sequelae of craniofacial trauma. We report our experiences in placing detachable coils in the management of rare cases of direct CCF after head injuries.

Methods: From January 2002 to December 2007, nine patients were admitted and treated for traumatic direct CCF at our hospital. The medical records and neuroimaging studies were retrospectively reviewed.

Results: All 9 patients had previous head trauma histories and ocular symptoms including exophthalmos, conjunctiva injection, and chemosis. Angiography was performed to confirm the CCF and for treatment planning. According to the angiograph, three patients had pseudo-aneurysms. All of the patients were treated with detachable coils via the trans-arterial endovascular maneuver. Among them, two patients had recurrences, the first at postoperative day one and the other eleven days after the surgery. Both recurrences were retreated endovascularly. All nine patients were successfully treated anigographically by means of trans-arterial embolization and improved symptomatically within a week.

Conclusion: The etiology of CCF, especially type A, is well known. Also, the advances in interventional neuroradiology and cranial base surgery are chiefly responsible for the evolution of treatment strategies for CCF. Although other techniques and approaches with other materials may be useful, embolization with detachable coiling, as used in our cases, can be a safe and effective method to occlude the fistula and to improve symptoms.

Keywords: Carotid cavernous fistula, Coil, Endovascular treatment, Head trauma.