title: Delayed detection of carotid-cavernous fistulas associated with wartime blast-induced craniofacial trauma.
abstract: Blast-induced neurotrauma is a leading cause of military casualties. Its effects on cerebrovascular structures are not well understood. Vascular injury resulting from overpressure shock wave impact may have a delayed presentation and detection. The authors present the cases of 2 patients who sustained blast-induced craniofacial trauma and brain injury. Detection of a cervical dissection was delayed in one patient, and detection of carotid-cavernous fistulas was delayed in both patients. The authors report the successful obliteration of both the dissection and the carotidcavernous fistulas via an endovascular approach. Endovascular management provides both a reasonable and effective therapeutic option to blast-induced cerebrovascular injuries.
authors.affiliation: National Capital Neurosurgery Consortium, Division of Neurosurgery, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Vadivelu
authors.forename: Randy Scott
authors.initials: RS
authors.lastname: Bell
authors.forename: Ben
authors.initials: B
authors.lastname: Crandall
authors.forename: Tom
authors.initials: T
authors.lastname: DeGraba
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Armonda
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000175:diagnosis / Q000601:surgery; D001930:Brain Injuries / Q000175:diagnosis / Q000601:surgery; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D020214:Cerebrovascular Trauma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000601:surgery; D057210:Delayed Diagnosis; D005107:Explosions; D005151:Facial Injuries / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000175:diagnosis / Q000601:surgery; D008887:Military Medicine; D014857:Warfare