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Endovascular targeted coil embolization using dual vessel approach for traumatic direct carotid cavernous fistula following severe head trauma:  technical notes

  • JUNYA TSURUKIRI1
  • TOSHIAKI ONITSUKA2
  • KEN MATSUSHIMA2
  • EITARO OKUMURA1
  • HIROYUKI JIMBO1

1Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan

2 Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan

DOI: 10.22514/SV131.042017.21 Vol.13,Issue 1,March 2017 pp.105-108

Published: 20 March 2017

*Corresponding Author(s): JUNYA TSURUKIRI E-mail: junya99@tokyo-med.ac.jp

Abstract

Direct carotid cavernous fistulas (dCCFs) represent different entitles from sponta-neous cavernous sinus (CS) dural arte-riovenous fistulas (CSAVFs). Traumatic dCCFs are direct arteriovenous communi-cations between the internal carotid artery (ICA) and cavernous sinus, resulting from a traumatic tear of the horizontal or pos-terior ascending intracavernous segment of the ICA by skull fracture fragments. They are account for 0.2–0.3% of crani-ofacial trauma and a serious problem that results in neuro-ophthalmologic symp-toms. Intracerebral hemorrhage followed by cortical venous reflux is a most serious complication. Although embolization of dCCFs with detachable balloons was pre-viously accepted worldwide as the first-line therapeutic option because it is tech-nically simple, these devices are currently unavailable and other treatment options have included coil embolization of the fis-tula to preserve the internal carotid artery. Therefore, sinus packing by coil emboliza-tion is now a first-line therapy, but there is the disadvantage of neuro-ophthalmologic symptoms by nerve palsy occurred in CS. In this study, we treated two patients with dCCFs caused by severe head trauma who underwent dual vessel approach to en-dovascular targeted coil embolization and successful resolution. We concluded that dual vessel approach to endovascular tar-geted coil embolization is an effective and safety technique among patients with trau-matic dCCFs.

Keywords

endovascular treatment, brain injury, dural arteriovenous fistulas, cavern-ous sinus, superior ophthalmic vein 

Cite and Share

JUNYA TSURUKIRI,TOSHIAKI ONITSUKA,KEN MATSUSHIMA,EITARO OKUMURA,HIROYUKI JIMBO. Endovascular targeted coil embolization using dual vessel approach for traumatic direct carotid cavernous fistula following severe head trauma: technical notes. Signa Vitae. 2017. 13(1);105-108.

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