Controversies in the Coil Embolization of Intracranial Aneurysms

GDC embolization has been performed selectively since 1991 in patients with intracranial aneurysms and made remarkable technical and clinical advances in recent years. But until now, this procedure lacks an adequate long-term follow-up study. Also, clear mechanism and evidence of electrothrombosis and endothelialization of aneurysm neck, the incidence of vasospasm after GDC embolization are still controversial. Here we critically reviewed the published literatures pertaining to the GDC embolization in order to gain a comprehensive understanding and knowledge of forementioned controversies. Also from November 1997 to April 1999, we treated 12 patients of intracranial aneurysms with GDC embolization. In conclusion, although certain shortcomings and controversies are still remain, the GDC embolization can be an alternative, supportive and attractive therapeutic modality in the treatment of intracranial aneurysms. Not only to improve outcome of intracranial aneurysms but also fulfill the patient's requirement, we need cooperations and cross-training with the interventional neuroradiology and rigorous academic evaluation on anatomy of cerebral vasculature and pathophysiology of cerebrovascular disorders.

Traumatic Carotid-Cavernous Fistula as a sequela of Mandibular Fracture

Traumatic carotid-cavernous fistula(CCF) is an uncommon situation resulting from trauma. The blood shunted from the internal carotid artery to the cavernous sinus results in pulsation exophthalmos,orbital headache, bruit, loss of visual acuity, diplopia, ophthalmoplegia. We were recently faced with such a case. The patient sustained fracture of the mandible during sports activity. Five months later, all the classic signs and symptoms of CCF had appeared. A carotid angiography confirmed the presence of a CCF. The management was achieved intravascularly by platinum electrothrombosis embolization. The main signs and symptoms of the CCF had resolved, but the patient remained in a visual loss of affected eye.