Endovascular treatment of traumatic Carotid Cavernous fistula : a case report

Authors

  • Aida Agastra MD Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania Author
  • Vojsava Leka MD Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania Author
  • Stela Dodaj MD Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania Author
  • Oneda Cibuku MD Department of Stroke Unit, UHC Mother Theresa, Tirana, Albania Author
  • Mirel Grada MD Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania Author
  • Eugen Enesi MD PhD Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania Author
  • Arben Rroji MD PhD Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania Author
  • Mentor Petrela MD, PhD, IFAANS, WANS* Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania Author

Keywords:

Carotido-Cavernous fistulas (CCF)trauma, endovascular, ophthalmoplegia

Abstract

Background: Direct carotid cavernous fistulas (dCCF) result from disruption of the cavernous internal carotid artery (ICA) causing direct shunting into the cavernous sinus1,2. Trauma is the most common cause of dCCF, as in our patient. The clinical presentation is a triade of chemosis, proptosis, and exophthalmos. Endovascular management is the current treatment for CCFs. Trans arterial or trans venous route are used for the endovascular treatment 1,3. 

Case presentation: A 75-year-old male presented one month after a traumatic brain injury from a syncope due to high blood pressure with bilateral exophthalmos, proptosis and eyelid swelling more expressed on the right side. Neurologic examination revealed:  bilateral ophthalmoplegias, amaurosis OD, right afferent pupillary reflex and right corneal reflex was absent, left hyporeactive corneal reflex, left pupilar reflex was present, in the auscultation bilateral temporal systolic noise and supraorbital pulsation were evident. 

On ophthalmologic evaluation bilateral papilledema with high intraocular pressure was noticed. A cerebral Digital Substraction Angiography (DSA) was performed. 

Direct right CCF, Type A according to Barrow was confirmed  and endovascular treatment was suggested.

Intervention:  Endovascular treatment  with direct detachable balloon occlusion of the right CCF under general anesthesia through arterial femoral access.

Embolization of the cavernous sinus with coiling under the protection ICA with a balloon.

Outcome:. After a first clinic impromevent, the conditions  worsened with progression of exophthalmos and proptosis bilaterally.

Another DSA was performed which showed re-opening of the right dCCF so embolization of the cavernous sinus with coiling was decided.

After the procedure, he was without systolic noise and supraorbital pulsation on auscultation bilaterally. Exophthalmos and proptosis were reduced and after 14 days visual acuity, ophthalmoplegia on the left eye improved.

Conclusion. dCCFs are a rare but treatable cause of cranial trauma. Endovascular embolization of CCFs with coiling or liquid agents is the only treatment.2 

 

 

 

 

Published

28-10-2025

Issue

Vol. 9 No. 1 (2025): Kosova Journal of Surgery, Volume 9, Issue 1

Section

Articles