Clinical improvement of patients with endovascular treatment in the traumatic carotid-cavernous fistula

Galih Permana; Nur Suroto; Asra Al Fauzi

doi:10.4103/ajns.AJNS_246_20

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 376-380
DOI: 10.4103/ajns.AJNS_246_20

Case Report

Clinical improvement of patients with endovascular treatment in the traumatic carotid-cavernous fistula

Autor*innen

Galih Permana

Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Airlangga University, Surabaya
Nur Suroto

Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Airlangga University, Surabaya
Asra Al Fauzi

Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Airlangga University, Surabaya

Abstract

A carotid-cavernous sinus fistula (CCF) is a clinical condition when there is an abnormal communication between the internal carotid artery, external carotid artery (ECA), or any of their branches to the cavernous sinus. Traumatic CCF (TCCF) is the most common type of all CCFs. This study aims to find clinical improvement of traumatic carotid-cavernous fistulas (TCCF) after endovascular treatment. We predict the degree of clinical recovery in an attempt to make the treatment of TCCF safe and effective. This study reported a series of 28 patients with TCCFs undergoing coiling and ballooning in a period of 3 years, i.e., from December 2014 to December 2017. This is a novel case report about CCF in our country, Indonesia, especially in Surabaya. We performed clinical, angiographical, and radiological assessments before and at regular time periods after the procedure until 6 months. All patients had a partial and complete occlusion of the fistula. Angiographic occlusion of fistula, visualization of the ophthalmic artery, and disappearance of bruit predicted a good clinical outcome. All patients made a recovery at different times, depending on the degree of fistulas and treatment. Improvement in clinical symptoms had a direct correlation with the degree of occlusion. Treatment was divided into coiling and ballooning depending on patient's condition and angiographic examination. Trans femoral cerebral angiography is still very important diagnostic tool in the diagnosis and treatment of TCCFs.

Key-words:

Cavernous sinus - endovascular embolization - traumatic carotid-cavernous fistulas - trans femoral cerebral angiography

Volltext

Referenzen

References
1 Joshi DK, Singh DD, Garg DD, Singh DH, Tandon DM. Assessment of clinical improvement in patients undergoing endovascular coiling in traumatic carotid cavernous fistulas. Clin Neurol Neurosurg 2016;149:46-54.
2 Tan AC, Farooqui S, Li X, Tan YL, Cullen J, Lim W, et al. Ocular manifestations and the clinical course of carotid cavernous sinus fistulas in Asian patients. Orbit 2014;33:45-51.
3 Ellis JA, Goldstein H, Connolly ES Jr., Meyers PM. Carotid-cavernous fistulas. Neurosurg Focus 2012;32:E9.
4 van Rooij WJ, Sluzewski M, Beute GN. Ruptured cavernous sinus aneurysms causing carotid cavernous fistula: Incidence, clinical presentation, treatment, and outcome. AJNR Am J Neuroradiol 2006;27:185-9.
5 Gonzalez LF, Chalouhi N, Tjoumakaris S, Jabbour P, Dumont AS, Rosenwasser RH. Treatment of carotid-cavernous fistulas using intraarterial balloon assistance: Case series and technical note. Neurosurg Focus 2012;32:E14.
6 Fattahi TT, Brandt MT, Jenkins WS, Steinberg B. Traumatic carotid-cavernous fistula: Pathophysiology and treatment. J Craniofac Surg 2003;14:240-6.
7 Tytle TL, Punukollu PK. Carotid cavernous fistula. Semi Cerebrovasc Dis Stroke 2001;1:83-111.
8 Helmke K, Krüger O, Laas R. The direct carotid cavernous fistula: A clinical, pathoanatomical, and physical study. Acta Neurochir (Wien) 1994;127:1-5.
9 Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985;62:248-56.
10 Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 1974;41:125-145.
11 Miller NR. Dural carotid-cavernous fistulas: Epidemiology, clinical presentation, and management. Neurosurg Clin N Am 2012;23:179-92.
12 de Keizer R. Carotid-cavernous and orbital arteriovenous fistulas: Ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit 2003;22:121-42.
13 Meyers PM, Halbach VV, Dowd CF, Lempert TE, Malek AM, Phatouros CC, et al. Dural carotid cavernous fistula: Definitive endovascular management and long-term follow-up. Am J Ophthalmol 2002;134:85-92.
14 Travers B. A case of aneurism by anastomosis in the orbit, cured by the ligature of the common carotid artery. Med Chir Trans 1811;2:1-420.1.
15 Kirsch M, Henkes H, Liebig T, Weber W, Esser J, Golik S, Kuhne D. Endovascular management of dural carotid cavernous sinus fistula in 141 patients. Neuroradiology 2006;48:486-90.
16 Lewis A, Tomsick TA, Tew JM. Management of 100 consecutive direct carotid cavernous fistula: Result of treatment with detachable baloons. Neurosurgery 1995;36:239-45.
17 Luo CB, Teng MM, Yen DH, Chang F, Lirng JF, Chang CY. Endovascular embolization of recurrent traumatic carotid cavernous fistulas managed previously with detachable ballons. J Trauma 2004;56:1214-20.
18 Wang W, Li YD, Li MH, Tan HQ, Gu BX, Wang J, et al. Endovascular treatment of post-traumatic direct carotid-cavernous fistulas: A single-center experience. J Clin Neurosci 2011;18:24-8.
19 Gupta AK, Purkayastha S, Krishnamoorthy T, Bodhey NK, Kapilamoorthy TR, Kesavadas C, et al. Endovascular treatment of direct carotid cavernous fistulae: A pictorial review. Neuroradiology 2006;48:831-9.
20 Morón FE, Klucznik PR, Mawad ME, Strother CM. Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement. Am J Neuroradiol 2005;26:399-1404.
21 Higashida RT, Halbach VV, Tsai FY, Norman D, Pribram HF, Mehringer CM, et al. Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: Results in 234 cases. AJR Am J Roentgenol 1989;153:577-82.
22 Joshi KC, Singh D, Tandon MS. Intrafistula pressure measurement in traumatic carotid cavernous fistulas − key to increasing safety and effectiveness of endovascular coiling. Acta Neurochir 2014;156:1695-700.
23 Pierot L, Moret J, Boulin A, Castaings L. Endovascular treatment of post-traumatic complex carotid-cavernous fistulas, using the arterial approach. J Neuroradiol 1992;19:79-87.
24 Teng MM, Chang CY, Chiang JH, Lirng JF, Luo CB, Chen SS, et al. Double-balloon technique for embolization of carotid cavernous fistulas. AJNR Am J Neuroradiol 2000;21:1753-6.
25 Ringer AJ, Salud L, Tomsick TA. Carotid cavernous fistulas: Anatomy, classification, and treatment. Neurosurg Clin N Am 2005;16:279-95, viii.
26 Morón FE, Klucznik RP, Mawad ME, Strother CM. Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement. AJNR Am J Neuroradiol 2005;26:1399-404.
27 Zanaty M, Chalouhi N, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P. Endovascular treatment of carotid-cavernous fistulas. Neurosurg Clin N Am 2014;25:551-63. [Doi: 10.1016/j.nec.2014.04.011].
28 Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid cavernous sinus fistula: A systematic review. World J Radiol 2013;5:143-55.