Treatment of traumatic carotid-cavernous fistula at the Udon Thani Center Hospital.
There are many options available in management of traumatic carotid-cavernous fistulae (CCF). The carotid occlusion or the carotid preservation techniques are two basic approaches available. This study evaluated the carotid occlusion technique performed at The Udon Thani Center Hospital. We retrospectively studied 12 consecutive cases of traumatic CCF. The patients varied in terms of their ages, gender, side of lesion and symptoms. The occlusion was performed with muscle occlusion and trapping of the carotid artery. The diagnosis was made clinically and on CT brain. The Matas test was performed clinically with external compression of the contralateral carotid artery. No patient underwent cerebral angiography. From August 1997 to June 2002 the 12 patients were treated by muscle embolization only; muscle embolization with internal carotid ligation (Brooks technique); muscle embolization with trapping (Jaeger-Hamby procedure); or muscle embolization with trapping and external carotid ligation. The patients ranged from 15 to 62 years. Eleven were male. All had unilateral fistulae though only 3 involved the left eye. Eleven patients were cured and there was only one major complication of a patient who developed a second and third nerve palsy. The carotid occlusion technique is less popular in view of the great advances with detachable balloons and success with carotid preservation techniques. Despite this, under extenuating circumstances such as the lack of angiography, poor socio-economic status, or patients wanting to be treated close to home, this procedure is still an appropriate therapeutic option, as reflected by the success at our hospital. The more affluent patients had wider options and thus were sent to other centers for carotid preservation techniques like detachable balloon embolization.
Thanapura
Chatchawan
C
Department of Surgery, Head of Neurosurgical Unit, Udon Thani Center Hospital, Udon Thani, Thailand.
D000293:Adolescent; D000328:Adult; D020216:Carotid-Cavernous Sinus Fistula / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006259:Craniocerebral Trauma / Q000150:complications*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed