Abstract

The goal of therapy in patients with traumatic carotid-cavernous fistulas is to occlude the fistula preferably while maintaining the carotid blood flow. Since the introduction of the concepts of detachable balloon technique to occlude arteriovenous fistulas, the technique has become the treatment of choice in the management of traumatic carotid-cavernous fistulas. The major symptoms of traumatic CCFs are (1) pulsating exophthalmos, (2) orbital and cephalic bruit and murmur, (3) headache, (4) chemosis, (5) extraocular palsies, and (6) visual failure. Traumatic CCFs are combined with multiple associated lesion. We tried the occlusion of fistulas using Goldvalve balloons in 8 consecutive cases of traumatic CCF and the result of our experience is reported. Transarterial approach with manually-tied latex balloons is tried in all cases and the fistulas was successfully occluded in all cases. In 5 cases, the internal carotid artery was preserved and the arterial lumen was occluded along with fistula opening in cases. In one case, surgical ligation was done because of symptoms recurred and incomplete occlusion of fistula. We experienced hemiparesis as a major complication in one case during occlusion tolerance test, which was remitted spontaneously. The results of Debrun balloon treatment were relatively excellent. We consider that the first choice of treatment of traumatic CCF is occlusion of the fistula by a detachable balloons.