Endovascular embolization of traumatic carotid cavernous fistulas

Objective To analyze the effectiveness of endovascular embolization on trea tment 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 Ins titute. Several kinds of balloon-catheter were used for embolization. Exter nal carotid-cavernous fistulas and rare carotid-cavernous fistulas (CCF) wi th minute leakage were treated by cyanoacrylate or coils. Although artery a pproach 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 successful ly, and 405 cases maintained the patency of internal carotid artery (ICA). No treatment-related deaths occurred and the symptoms and signs of 462 case s were relieved after embolization. Emergency embolization was needed in so me conditions such as serious epistaxis, delayed or repeated subdural hemat oma, 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.