Caroticocavernous fistula management by detachable balloon at different clinical stages

The authors describe their first experience in transarterial balloon embolization in the treatment of CCF. Six patients presenting with traumatic CCF were included in the study during the period between 1990 and 1993. All had an established clinical diagnosis after thorough neurological and ophthalmological assessment together with positive radiological evidence through head computed tomography and cerebral angiography. They ranged in age between 15 and 55 years. All were males except one. They presented mainly with machinery bruit and exophthalmos. Proptosis was unilateral in five patients and bilateral in the remaining one. Favourable results were obtained. Post- embolization improvement, and even normalization, set-in in five of the six patients regarding bruit and proptosis without any resultant complications. Only in a single patient delayed balloon deflation and intracranial migration occurred with consequent major cerebral infarction and death. The authors conclude that transarterial balloon embolization remains the procedure of choice in the treatment of symptomatic CCF. However, transvenous embolization is an alternative when the arterial route fails

Superselective endovascular embolization of brain arteriovenous malformations [BAVMS]

The authors describe their experience with fifteen BAVMs treated by superselective endovascular embolization alone. Five patients presented with intracranial hemorrhage; four with intractable seizures; three with severe headaches; two with progressive neurological deficit and one with diplopia. In 9 cases, obliteration of 50- 75% of the AVM nidus was achieved and in in 3 cases this precentage increased to between 75 and 90%. Complete obliteration of AVM nidus was achieved in two cases. In only a single patient there was no significant obliteration at all. No mortality related to embolization procedure with only negligible percentage of morbidity being reversible. Short term [3ws]. outcome showed improvement in almost all the cases. Only in a single patient with massive cerebellar hemorrhage death occurred. Endovascular embolization of brain arteries malformations [BAVMs] using microcatheters a liquid acrylic material is a useful addition to the methods of treating and controlling such a complex problem