title: Multiple unilateral traumatic carotid-cavernous sphenoid sinus fistulas with associated massive epistaxis: a consequence of parkour.
abstract: BACKGROUND
  Traumatic carotid-cavernous fistulas (CCFs) present the clinician with diagnostic and surgical challenges. Extension of a CCF into the sphenoid sinus presents additional management difficulties. Endovascular interventions using various thrombogenic materials such as balloons, coils, or liquids are effective treatment strategies. Ideally, these techniques are used to obliterate the fistula while maintaining the patency of the parent artery.
  
  
  METHODS
  We present a rare case of traumatic carotid-cavernous sphenoid sinus fistulas complicated by multiple tears in the internal carotid artery with direct communication to the cavernous and sphenoid sinus. As a result, the patient developed massive epistaxis requiring emergent endovascular intervention. A total of 87 detachable coils were placed into the cavernous and sphenoid sinuses via transarterial and transvenous routes in a staged procedure, resulting in complete obliteration of the patient's multiple fistulas.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case of multiple fistulous tears in the internal carotid artery with extension to the cavernous and sphenoid sinus. This report emphasizes the importance of early diagnosis and neurosurgical intervention.
authors.affiliation: Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA.
authors.forename: Jason F
authors.initials: JF
authors.lastname: Harrison
authors.affiliation: Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA.
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Vega
authors.affiliation: Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA.
authors.forename: Theofilos G
authors.initials: TG
authors.lastname: Machinis
authors.affiliation: Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA.
authors.forename: John F
authors.initials: JF
authors.lastname: Reavey-Cantwell
keywords: Aneurysm–false; carotid-cavernous sinus fistula; embolization–therapeutic; trauma–nervous system
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