Traumatic carotid-cavernous fistula: Clinical presentation and outcome

Objective:To evaluate the presentation, clinical course and outcome of traumatic carotid-cavernous fistula (CCF) withendovascular treatment at our institution during the last five years. Design: Retrospective descriptive study. Setting: The study included patients seen at Aga Khan University Hospital from January 2000 to December 2005. Methods: Retrospective analysis based on data retrieval from medical records using ICD coding system. Only those cases who had traumatic CCF and underwent endovascular treatment were included in the study. Results: A total of 8 patients were diagnosed with post-traumatic CCF and 11 procedures were done. Mean age at presentation was 35.6 years; mean duration of symptoms was 23 weeks after trauma; 6 patients were male and 2 female. Patients presented from 1 week to 2 years after the trauma; 7 had high-flow fistulas and 1 had low-flow fistula. Proptosis was the most common symptom (6 patients); decreased vision was present in 3 patients; 4 patients had an accompanying skull base fracture; and 1 patient had bilateral CCF. All patients were treated by endovascular procedures; 2 patients had recurrences, seen within 1 month of initial treatment and subsequently successfully treated. In 1 patient, the procedure failed due to the small size of the fistula. Conclusion: High success rate with minimal complications as seen in our series supports endovascular treatment as the leading option for CCF management