J Neurol Surg A Cent Eur Neurosurg 2013; 74(S 01): e76-e80
DOI: 10.1055/s-0032-1329269
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Posttraumatic Carotid-Cavernous Fistula Associated with Evolving Contralateral Internal Carotid Artery Pseudoaneurysm

Arun Sharma
1   Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, Delhi, India
,
Rahul Gupta
1   Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, Delhi, India
,
Daljit Singh
1   Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, Delhi, India
,
Hukum Singh
1   Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, Delhi, India
› Author Affiliations
Further Information

Publication History

19 September 2011

17 April 2012

Publication Date:
05 September 2013 (online)

Abstract

Head trauma can result in vascular injuries at the base of skull. We present a unique case of carotid-cavernous fistula (CCF) on one side with evolving contralateral internal carotid artery (ICA) aneurysm resulting from a single trauma. There were different pathomechanisms involved in the development of these lesions. Both these lesions were successfully managed with endovascular coiling. The case cautions us about a potential threat of another delayed lesion forming on contralateral side once an ipsilateral posttraumatic vascular lesion has been treated. The case also highlights the importance of carefully looking for the ICA on both sides during digital subtraction angiography in trauma patients.

 
  • References

  • 1 Debrun G, Lacour P, Vinuela F, Fox A, Drake CG, Caron JP. Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 1981; 55 (5) 678-692
  • 2 Lewis AI, Tomsick TA, Tew Jr JM. Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery 1995; 36 (2) 239-244 , discussion 244–245
  • 3 Acosta C, Williams Jr PE, Clark K. Traumatic aneurysms of the cerebral vessels. J Neurosurg 1972; 36 (5) 531-536
  • 4 Debrun GM, Viñuela F, Fox AJ, Davis KR, Ahn HS. Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery 1988; 22 (2) 285-289
  • 5 Gupta AK, Purkayastha S, Krishnamoorthy T , et al. Endovascular treatment of direct carotid cavernous fistulae: a pictorial review. Neuroradiology 2006; 48 (11) 831-839
  • 6 Sencer S, Minareci O, Poyanli A. Posttraumatic damage to the internal carotid artery: pseudoaneurysm presenting with epistaxis and direct carotid cavernous fistula. Turk Neurosurg 2002; 12: 128-134
  • 7 Wang W, Li YD, Li MH , et al. Endovascular treatment of post-traumatic direct carotid-cavernous fistulas: a single-center experience. J Clin Neurosci 2011; 18 (1) 24-28
  • 8 Voigt K, Sauer M, Dichgans J. Spontaneous occlusion of a bilateral caroticocavernous fistula studied by serial angiography. Neuroradiology 1971; 2 (4) 207-211
  • 9 Parkinson D. Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg 1973; 38 (1) 99-106
  • 10 Iwai R, Horie Y, Nishijima M, Oka N, Tsukamoto E. [Spontaneous cure of traumatic carotid cavernous fistula after orbital venography: case report]. No Shinkei Geka 1984; 12 (2) 199-203
  • 11 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 (1) 185-189
  • 12 Haddad FS, Haddad GF, Taha J. Traumatic intracranial aneurysms caused by missiles: their presentation and management. Neurosurgery 1991; 28 (1) 1-7
  • 13 Wang X, Chen JX, You C, He M. Surgical management of traumatic intracranial pseudoaneurysms: a report of 12 cases. Neurol India 2008; 56 (1) 47-51
  • 14 Parkinson D, West M. Traumatic intracranial aneurysms. J Neurosurg 1980; 52 (1) 11-20
  • 15 Miley JT, Rodriguez GJ, Qureshi AI. IQ Traumatic intracranial aneurysm formation following closed head injury. J Vasc Intervent Neurol 2008; 1 (3) 79-82
  • 16 Jou LD, Mawad ME. Growth rate and rupture rate of unruptured intracranial aneurysms: a population approach. Biomed Eng Online 2009; 8: 11
  • 17 Méndez JC, González-Llanos F. Endovascular treatment of a vertebral artery pseudoaneurysm following posterior C1-C2 transarticular screw fixation. Cardiovasc Intervent Radiol 2005; 28 (1) 107-109
  • 18 Eskandari MK. Commentary. Carotid artery stents for blunt cerebrovascular injury. Perspect Vasc Surg Endovasc Ther 2006; 18 (1) 73-74