Endovascular Occlusion of Traumatic Carotid Cavernous Fistula by Using Detachable Balloon in Various Ways: A Case Series

Abstract

Introduction The detachable balloons are not frequently used nowadays for endovascular occlusion of carotid-cavernous fistula (CCF) because of lack of availability and supposed high risk of recurrence. This study describes the various way of detachable balloon embolization for traumatic CCF.

Materials and Methods We have used endovascular detachable balloon to occlude the traumatic CCF under local anesthesia in various ways in 12 traumatic cases of CCF from March 2013 to April 2015. Clinical and computed tomographic (CT) angiography follow-up was done at 6 and 12 months.

Results Clinical follow-up from 6 to 12 month showed persistent resolution of symptoms in 10 cases; 2 cases had developed slight proptosis and chemosis. CT angiography done in nine cases after 6 to 9 months showed no residual filling in CCF.

Conclusion The detachable balloon either single or double with or without coils can be used in the management of CCF by different methods. Detachable balloon is a cheaper alternative compared with coiling. It is technically easier to perform and can be performed under local anesthesia.

Keywords

traumatic carotid-cavernous fistula - detachable balloons - endovascular management

• References

• 1 Shownkeen H, Bova D, Origitano TC, Petruzzelli GJ, Leonetti JP. Carotid-cavernous fistulas: pathogenesis and routes of approach to endovascular treatment. Skull Base 2001; 11 (03) 207-218
• 2 Chuman H, Trobe JD, Petty EM. et al. Spontaneous direct carotid-cavernous fistula in Ehlers-Danlos syndrome type IV: two case reports and a review of the literature. J Neuroophthalmol 2002; 22 (02) 75-81
• 3 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 (02) 248-256
• 4 Viñuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG. Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 1984; 60 (05) 976-984
• 5 Kinugasa K, Tokunaga K, Kamata I. et al. Selection and combination of techniques for treating spontaneous carotid-cavernous sinus fistulas. Neurol Med Chir (Tokyo) 1994; 34 (09) 597-606
• 6 Lewis AI, Tomsick TA, Tew Jr JM. Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery 1995; 36 (02) 239-244 discussion 244–245
• 7 Xu XQ, Liu S, Zu QQ. et al. Follow-up of 58 traumatic carotid-cavernous fistulas after endovascular detachable-balloon embolization at a single center. J Clin Neurol 2013; 9 (02) 83-90
• 8 Teng MM, Chang CY, Chiang JH. et al. Double-balloon technique for embolization of carotid cavernous fistulas. AJNR Am J Neuroradiol 2000; 21 (09) 1753-1756