Clinical Analysis of Traumatic Carotid-Cavernous Fistula

ABSTRACT

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.