title: Systematic Analysis of the Risk Factors Affecting the Recurrence of Traumatic Carotid-Cavernous Sinus Fistula.
abstract: OBJECTIVE
  The current therapies for traumatic carotid-cavernous sinus fistula (tCCF) yield a variable rate of recurrence and produce different results. We analyzed factors among traumatic head injury to identify the risk factors in recurrent tCCFs.
  
  
  METHODS
  We retrospectively reviewed patients who were diagnosed with tCCFs from January 2004 to December 2014 in a tertiary referral center. The factors that were analyzed included age, sex, associated injury, clinical presentation, interval from injury to interventions, interventions for tCCFs, and pathologic characters of tCCFs under digital subtraction angiography.
  
  
  RESULTS
  A total of 55 patients with 56 tCCFs (1 bilateral tCCF) were included. Thirty-nine patients (40 tCCFs) were treated successfully in single session of a procedure, whereas 16 patients (16 tCCFs) experienced a recurrence of tCCF. In multivariate analysis, we found that the involvement of C2 or C4 segments (Debrun classification) of intracavernous internal carotid artery is an independent risk factor (hazard ratio [HR] 2.95, 95% confidence interval [95% CI] 1.34-6.52; P < 0.01) for the recurrence of tCCFs. Endovascular coil embolization demonstrated superior efficacy in successful interventions of tCCFs compared with detachable balloons (HR 2.63, 95% CI 1.06-6.57; P < 0.05) and other modalities (HR 3.06, 95% CI: 1.27-7.37; P < 0.05).
  
  
  CONCLUSIONS
  A detachable coil is a favorable approach in the management of tCCFs when considering the rate of recurrence. In addition, the involvement of C2 or C4 segments (Debrun classification) served as an independent risk factor of the recurrence of tCCFs.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tzu-Chin
authors.initials: TC
authors.lastname: Lin
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shih-Hsuan
authors.initials: SH
authors.lastname: Mao
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Neuroradiology and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yao-Liang
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Neuroradiology and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ho-Fai
authors.initials: HF
authors.lastname: Wong
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan; Statistical center for clinical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chee Jen
authors.initials: CJ
authors.lastname: Chang
authors.affiliation: Department of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Taiwan. Electronic address: ns3068@gmail.com.
authors.forename: Yin-Cheng
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D020216:Carotid-Cavernous Sinus Fistula / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Debrun classification; Detachable coils; Endovascular embolization; Recurrence; Traumatic carotid-cavernous sinus fistula