Back to Journals » International Journal of General Medicine » Volume 13

Neuro-Endovascular Intervention in Traumatic Carotico-Cavernous Fistulae: A Single-Center Experience

Authors Thohar Arifin M, Ali Akbar M, Illyasa W, Tsaniadi Prihastomo K

Received 23 July 2020

Accepted for publication 17 August 2020

Published 21 October 2020 Volume 2020:13 Pages 917—925


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Muhamad Thohar Arifin, Mohammad Ali Akbar, Widianto Illyasa, Krisna Tsaniadi Prihastomo

Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia

Correspondence: Muhamad Thohar Arifin
Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia

Introduction: The aim of this research was to describe a single-center practical experience in the management of traumatic carotid cavernous fistula (CCF).
Methods: There were a total of 31 patients between January 2005 and December 2019 with post-traumatic carotid cavernous sinus fistula (tCCF) who underwent treatment. We classified them into 2 types according to the flow of the CCF: patients with high flow CCF and patients with low flow CCF.
Results: Angiography revealed the high flow types on 21 patients (67.7%), the mean of patients ages are 31.5 years. Onyx embolization was performed in 1 patient (4.76%), transarterial balloon embolization was carried out in 10 patients (47.61%), transarterial coiling in 3 (14.28%) patients while 5 (28.8%) patients underwent transvenous routes to insert the coil and 2 patients (9.52%) were treated conservatively. Complete occlusion was achieved on all patients with coiling whereas the other treatment experiences the reducing flow of the fistula. We obtained 10 patients (32.2%) with a mean of 40.3 years as low flow type CCF. The patients with the low flow type mostly treated conservatively, because their symptoms were acceptable and intermittent.
Conclusion: The ballooning currently became the more affordable treatment in our center. Balloon embolization was recommended for medium- and large-size fistula. The coils should be recommended for small-size fistula. In some cases occlusion of the fistula cannot be obtained using the detachable balloon, a coil can be used to occlude the cavernous sinus via trans arterial or trans venous access. If the fistula failed to be treated in traditional ways using balloons or coils, occlusion of the parent vessels could be another option.

Keywords: trauma, carotid cavernous sinus fistula, angiography, embolization, transarterial, transvenous

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]