title: Successful Coil Embolization of Pediatric Carotid Cavernous Fistula Due to Ruptured Posttraumatic Giant Internal Carotid Artery Aneurysm.
abstract: BACKGROUND
  The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully.
  
  
  METHODS
  A 6-year-old boy had severe head trauma caused by being hit by a car. He was transferred to our department and diagnosed as having left acute subdural hematoma and acute brain swelling. Emergent evacuation of hematoma and external decompression were performed. He was treated for severe brain swelling in the intensive care unit for 2 months. Cranioplasty was performed 3 months after the injury. His right hemiparesis and aphasia persisted, so he was transferred to a rehabilitation hospital. However, 2 years after the head injury, he was referred to our department because of abducens nerve palsy. He was diagnosed as having a symptomatic posttraumatic direct CCF, which was caused by a ruptured left cavernous giant internal carotid artery aneurysm. The direct CCF was treated with coil embolization of the giant aneurysm and parent artery occlusion.
  
  
  CONCLUSIONS
  Coil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan. Electronic address: wajima@naramed-u.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Wajima
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hun Soo
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D002426:Cavernous Sinus / Q000601:surgery; D002648:Child; D017023:Coronary Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D015898:Tomography Scanners, X-Ray Computed
keywords: Cavernous ICA giant aneurysm; Coil embolization; Posttraumatic direct carotid cavernous sinus fistula (CCF)