Combined Surgery and Endovascular Treatment of Complicated Traumatic Carotid-Cavernous Fistulas: Results and Illustrated Cases

Authors

  • Theerapol Witthiwej Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Nanthasak Tisavipat Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Prajak Sae-sue Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Sarun Nanta-Aree Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Montri Luxsuwong Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Voravut Chanyavanich Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Pipat Chiewvit Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Anchalee Churojana Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Suttisak Suttipongchai Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University

Keywords:

Balloon embolization, Carotid cavernous fistulas, Cavernous sinus packing, ndovascular treatment

Abstract

Objective: To review Siriraj Hospital’s experiences with direct surgical treatment of complicated traumatic carotid-cavernous fistulas (CCFs) in the context of multidisciplinary approach.
Methods: This study is a retrospective review of complicated direct carotid cavernous fistulas (CCFs) that had opened surgery after failure of detachable balloon embolization. Data were collected from medical records, radio-angiographic records, and follow-up results of combinations of treatment.
Results: From 1993- April 2003, we have total 25 cases of combined surgery and endovascular treatment of traumatic carotidcavernous fistulas (CCFs). Causes of unsuccessful balloon embolization are small-hole fistula, deflation of the balloon, difficult position of fistula, false aneurysm, risk of intracavernous internal carotid artery (ICA) occlusion, and tortuosity of ICA and draining veins. Various procedures were performed and all patients have good results with completed resolution of clinical triad symptoms. On follow-up cerebral angiography of 16 patients that received cavernous sinus packing, we could preserve the patency of ICA in 8 patients but 5 patients had thrombosis of ICA without ischemic events. In 3 patients, an operation to occlude the ICA was performed after failure of cavernus sinus packing.
Conclusions: The standard treatment of carotid cavernous fistula is endovascular balloon embolization. When the endovascular treatment fails, surgical packing of cavernous sinus is immediately considered an alternative way to cure the CCFs and to offer additional technique to help increase the patency of ICA.

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Published

01-06-2006

How to Cite

Witthiwej, T. ., Tisavipat, N. ., Sae-sue, P. ., Nanta-Aree, S. ., Luxsuwong, M., Chanyavanich, V., Chiewvit, P. ., Churojana, A. ., & Suttipongchai, S. . (2006). Combined Surgery and Endovascular Treatment of Complicated Traumatic Carotid-Cavernous Fistulas: Results and Illustrated Cases. Siriraj Medical Journal, 58(6), 853–860. Retrieved from https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/245843

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Original Article