Traumatic indirect carotid cavernous fistulas: angioarchitectures and results of transarterial embolization by liquid adhesives in 11 patients.
BACKGROUND
The angioarchitectures of traumatic indirect CCFs and the effectiveness and safety of transarterial liquid adhesive embolization for these fistulas remain to be evaluated.


METHODS
A total of 276 consecutive patients with traumatic craniofacial arteriovenous fistula were referred for embolization in the past 15 years. Eleven had traumatic indirect CCFs and were managed with transarterial liquid adhesive embolization. This group was composed of 8 men and 3 women ranging from 15 to 46 years of age. The most frequently observed symptoms were neuro-ophthalmic, followed by bruit and headache. All lesions were single fistula and fed exclusively by meningeal artery. The accessory meningeal artery was involved most often (n = 7), followed by the middle meningeal artery (n = 4). Venous drains were the ophthalmic vein (n = 11) and/or inferior petrous sinus (n = 8). No cortical vein drainage was observed. Liquid adhesives (60%) were used to obliterate all fistulas; 2 patients were also treated with detachable coils.


RESULTS
All fistulas were totally occluded with resolutive fistula-related symptoms. Asymptomatic migration of liquid adhesives into the nearby arterial branch was observed in 1 patient. One patient had partial ocular choroidal infarction. No recurrent or residual fistula was found upon clinical follow-up.


CONCLUSIONS
Angioarchitecture and treatment of traumatic indirect CCFs differed from the spontaneous type of fistulas. By transarterial liquid adhesive embolization, treatment of all fistulas was safe, with effective occlusion and associated low peri-procedural risk. This procedure may be considered as the primary treatment for these traumatic fistulas.
Luo
Chao-Bao
CB
Department of Radiology, Taipei Veterans General Hospital, and National Yang Ming University School of Medicine, Taipei, Taiwan, ROC. cbluo@vghtpe.gov.tw
Teng
Michael Mu-Huo
MM
Chang
Feng-Chi
FC
Chang
Cheng-Yang
CY
D000293:Adolescent; D000328:Adult; D017130:Angioplasty; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D004659:Enbucrilate