Endovascular embolization of traumatic carotid cavernous fistulas

Objective To analyze the effectiveness of endovascular embolization on treatment of traumatic carotid-cavernous fistula (TCCF). Methods From 1986 to 1997, 482 cases of traumatic carotid-cavernous fistula were treated by endovascular embolization in the Beijing Neurosurgical Institute. Several kinds of balloon-catheter were used for embolization. External carotid-cavernous fistulas and rare carotid-cavernous fistulas (CCF) with minute leakage were treated by cyanoacrylate or coils. Although artery approach was applied in most cases (477 cases), vein approach showed its own advantages in some special cases. Results We found a special "bileakage sign" indicating multileakage of TCCF, which was never mentioned before. All 482 cases were embolized successfully, and 405 cases maintained the patency of internal carotid artery (ICA). No treatment-related deaths occurred and the symptoms and signs of 462 cases were relieved after embolization. Emergency embolization was needed in some conditions such as serious epistaxis, delayed or repeated subdural hematoma, and rapid visual impairment. Conclusion Endovascular embolization of TCCF is a safe and efficient method. Carefully selected operation time, operative approach, and materials are the essential factors to reach a best result.