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

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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