Rare Recurrence of Traumatic Carotid Cavernous Fistula after Parent Artery Occlusion—Report of Two Cases and Review of Literature

Abstract

The authors present two cases of recurrence of traumatic carotid cavernous fistula (CCF) following complete exclusion by parent artery occlusion (PAO). In both cases, the fistula recurred through the development of indirect CCF and reconstitution of the occluded artery through the development of vasa vasorum or simple recanalization of the parent artery. The cavernous venous sac was patent in both cases. The patent cavernous sac along with the inflammatory or angiogenetic factors might have induced dural neovascularization leading to the development of indirect CCF. These factors along with ischemia of the arterial wall secondary to the steal phenomenon due to persistent shunt flow would have triggered the development of vasa vasorum. Thus the cavernous sac embolization may have to be considered in addition to PAO when PAO is planned as a therapeutic option for direct CCF.

Keywords

carotid cavernous fistula - parent artery occlusion - posttraumatic - recurrence - vasa vasorum

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