title: Traumatic cerebral aneurysm associated with a contralateral traumatic carotid cavernous fistula. A case report.
abstract: This report documents the management of a traumatic carotid aneurysm (TCA) with a traumatic carotid-cavernous fistula (T-CCF) of the contralateral internal carotid artery (ICA) following a closed head injury. A 38-year-old man presented with severe traumatic subarachnoid hemorrhage and pneumocephalus due to a severe head injury. Four months after the accident, the patient presented with clinical symptoms of exophthalmos and retroorbital bruit. Cerebral angiography showed a TCA of the IC-PC region, which coexisted with a contralateral T-CCF. Both lesions were successfully managed with an endovascular treatment using coils to isolate a fistula from the ICA, and direct surgical trapping of the intracranial ICA to eliminate a TCA. Post-operative angiography revealed a good cross-flow through the anterior communicating artery from the contralateral ICA, which was completely obliterated by the T-CCF. No additional surgical or endovascular procedure for traumatic vascular injuries was required. The patient remained asymptomatic during the clinical follow-up period of 24 months. The goal of traumatic carotid injuries is the selective elimination of the vascular pathologic injury with asymptomatic state, using direct surgery and/or an endovascular treatment.
authors.affiliation: Dep. of Emergency & Critical Care Medicine, Nippon Medical School, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Fuse
authors.forename: H
authors.initials: H
authors.lastname: Yokota
authors.forename: S
authors.initials: S
authors.lastname: Kominami
authors.forename: Y
authors.initials: Y
authors.lastname: Yamamoto