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


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:


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.


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

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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.


1. Higashida RT, Halbach VV, Tsai FY, Norman D, Pribram HF, Mehringer CM, et al. Interventional neurovascular treatment of traumatic carotid and vertebral artery lesion: results in 234 cases. AJR Am J Roentgenol 1989 Sep;153(3):577-82. DOI: 10.2214/ajr.153.3.577.

2. Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid cavernous sinus fistula: a system-atic review. World J Radiol 2013 Apr;5(4):143-55. doi: 10.4329/wjr.v5.i4.143.

3. Lu X, Hussain M, Ni L, Huang Q, Zhou F, Gu Z, et al. A Comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients. J Vasc Interv Neurol 2014 Dec;7(5):35-47.

4. Agid R, Willinsly RA, Haw C, Souza MP, Vanek IJ, terBrugge KG. Targeted compartmental embolization of cavernous sinus dural arteriovenous fistulae using transfemoral medial and lateral facial vein approaches. Neuroradiology 2004 Feb;46(2):156-60.

5. Wang W, Li YD, Li MH, Tan HQ, Gu BX, Wang J, et al. Endovascular treatment of post-traumatic direct carotid-cavernous fistulas: A single-center experience. J Clin Neurosci 2011 Jan;18(1):24-8. doi: 10.1016/j.jocn.2010.06.008.

6. Niu Y, Li L, Tang J, Zhu G, Chen Z. Embolization of direct carotid cavernous fistulas with the novel double-balloon technique. Interv Neurodaiol 2016 Apr;22(2):201-5. doi: 10.1177/1591019915609779.

7. Bink A, Goller K, Lüchtenberg M, Neumann-Haefelin, Dützmann S, Zanella F, et al. Long-term outcome after coil embolization of cavernous sinus arteriovenous fistulas. AJNR Am J Neuroradiol 2010 Aug;31(7):1216-21. doi: 10.3174/ajnr.A2040

8. Nishino K, Ito Y, Hasegawa H, Kikuchi B, Shimbo J, Kitazawa K, et al. Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula: association with the volume and location of detachable coils. J Neurosurg 2008 Aug;109(2):208-14. doi: 10.3171/JNS/2008/109/8/0208.

9. Dos Santos D, Monsignore LM, Nakiri GS, Cruz AA, Colli BO, Abud DG. Imaging diagnosis of dural and direct cavernous carotid fistulae. Radiol Bras 2014 Jul-Aug;47(4):251-5. doi: 10.1590/0100-3984.2013.1799.

10. Lee JY, Jung C, Ihn YK, Kim DJ, Seong SO, Kwon BJ. Multiditector CT angiography in the diagnosis and classification of carotid-cavernous fistula. Clin Radiol 2016 Jan;71(1):e64-71. doi: 10.1016/j.crad.2015.10.018

11. Baxter BW, Rosso D, Lowine SP. Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. Am J Neuroradiol 1998 Jun-Jul;19(6):1176-8.

12. Shin YS, Kim D, Lee SI, Chung JI, Yoon PH, Lee KC. The Usefulness of the New “Double-Catheter Technique” in the Treatment of Parent Artery Incorporated Wide-Necked Aneurysm with Guglielmi Detachable Coils. Interv Neuroradiol 2000 Mar;6(1):61-4.

13. Andrade G, Ponte De Souza ML, Marques R, Silva JL, Abath C, Azevedo-Filho HR. Endovascular treatment of traumatic carotid cav-ernous fistula with balloon-assisted sinus coiling. A technical description and initial results. Interv Neuroradiol 2013 Dec;19(4):445-54.

14. De Renzis A, Nappini S, Consoli A, Renieri L, Limbucci N, Rosi A, et al. Balloon-assisted coiling of the cavernous sinus to treat direct carotid cavernous fistula. A single center experience of 13 consecutive patients. Interv Neuroradiol 2013 Sep;19(3):344-52.

15. Nossek E, Zumofen D, Nelson E, Raz E, Potts MB, Desousa KG, et al. Use of pipeline embolization devices for treatment of direct carotid-cavernous fistula. Acta Neurochir 2015 Jul;157(7):1125-9. doi: 10.1007/s00701-015-2446-0.

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