title: Assessment of clinical improvement in patients undergoing endovascular coiling in traumatic carotid cavernous fistulas.
abstract: OBJECTIVE
  We attempt to find key points in endovascular coiling which can help us predict degree of clinical recovery, in an attempt to make the treatment of CCF safe and effective.
  
  
  METHODS
  We analyzed a series of 15 patients with traumatic CCFs undergoing coiling by performing clinical, angiographical and radiological assessment before and at regular time periods after the procedure till 6 months. The findings were analyzed to find critical points predicting clinical outcome in each of the patients.
  
  
  RESULTS
  80% patients had complete occlusion of fistula (n=12) with a 100% ICA patency rate. Angiographic occlusion of fistula, visualization of ophthalmic artery and disappearance of bruit predicted a good clinical outcome. Cranial nerve palsies and fixed neurological deficits do not always reverse suggesting an alternate etiopathology.
  
  
  CONCLUSIONS
  The degree of occlusion had direct correlation with improvement in clinical symptoms, which was remarkable when the extent of occlusion was more than 90%. To our knowledge this is one of the largest series in published literature on clinical outcomes of patients with traumatic CCFs using detachable coils as the embolizing agent and can serve as standard for comparison for future treatment alternatives.
authors.affiliation: Institute of Neurosciences, M S Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore, Karnataka 560055, India. Electronic address: krishnacjoshi@yahoo.com.
authors.forename: Dr Krishna Chaitanya
authors.initials: DK
authors.lastname: Joshi
authors.affiliation: Department of Neurosurgery, G B Pant Hospital, New Delhi, 110002, India. Electronic address: drdaljit@hotmail.com.
authors.forename: Dr Daljit
authors.initials: DD
authors.lastname: Singh
authors.affiliation: Department of Neuro anesthesia, M. S. Ramaiah Medical College, Bangalore 560055, India. Electronic address: deepa_garg10@yahoo.co.in.
authors.forename: Dr Deepali
authors.initials: DD
authors.lastname: Garg
authors.affiliation: Department of Neurosurgery, G B Pant Hospital, New Delhi, 110002, India. Electronic address: drhsingh2008@yahoo.com.
authors.forename: Dr Hukum
authors.initials: DH
authors.lastname: Singh
authors.affiliation: Department of Neuroanesthesia, G B Pant Hospital, 110002, India. Electronic address: monicastandon@hotmail.com.
authors.forename: Dr Monica S
authors.initials: DM
authors.lastname: Tandon
mesh_terms: D000293:Adolescent; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging; D017063:Outcome Assessment, Health Care; D055815:Young Adult
keywords: Carotid cavernous fistulas; Endovascular coiling; Retro orbital edema; Superior ophthalmic vein