Diagnosis and treatment of traumatic carotid cavernous fistula.

OBJECTIVE

To discuss the diagnosis and management of traumatic carotid cavernous fistula (TCCF).

METHODS

In all 15 patients with TCCF confirmed by angiography, 8 patients got early diagnosis and cure. With Seldinger technique adopted in the puncture of femoral artery, Magic 3 F-1.8 F BD catheters combining with balloon were used to embolize the fistula or the internal carotid artery.

RESULTS

Early diagnosis and cure were achieved in 8 patients within one week and no sequelae occurred. Seven patients with delayed diagnosis who were cured beyond one week had some sequelae such as hypopsia in 5 cases, incomplete oculomotor paralyses in 3 and incomplete abducent paralyses in 2. Among all the 15 cases, the internal carotid artery was preserved in 12 cases accounting for 80%. Occluding the fistula with sacrifice of the internal carotid artery was performed in 3 cases and no repatency of the fistula occurred by following up beyond three months.

CONCLUSIONS

The preferred therapy for TCCF is to occlude the fistula using detachable balloon. The diagnosis and treatment for TCCF can significantly reduce occurrence rate of the complications and sequelae.