Treatment of 54 traumatic carotid-cavernous fistulas

Publisher Website
Google Scholar
Abstract
A series of 54 traumatic carotid-cavernous fistulas were treated with detachable balloon catheters. The balloon was introduced through 1 of 3 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 3 cases where both the fistula and the carotid artery were originally occluded by the balloon, the superior portion of the fistula was completely occluded. These patients had intracranial ligation of the supraclinoid portion of the carotid artery. Three patients had hemiparesis, transient in 2 cases and permanent in the other. The fistula was totally occluded in 53 cases; in the 1 exception the patient became asymptomatic but had a minimal angiographic leak.