Posttraumatic carotid cavernous fistula: Frequency analysis of signs, symptoms, and disability outcomes after angiographic embolization

Objective: To increase awareness and understanding of posttraumatic carotid cavernous fistula (PTCCF) with the intent to expedite diagnosis and treatm ent of this disabling injury, a 14-year retrospective review of patients wi th angiographically identified PTCCF was conducted at this Level I trauma c enter, A frequency analysis of signs, symptoms, and disability was performe d. The impact on disability of demographics, number of embolization attempt s required for closure of the PTCCF, and time from injury to diagnosis was assessed by t test for independent samples. Results: Nine patients were diagnosed with 10 PTCCFs, Mean patient age was 41.5 Sears. All patients with PTCCF had basilar skull fracture, loss of con sciousness, bruit, and chemosis; 90% had exophthalmos; 70% had visual chang es; 50% complained of headache; and 80% had some lasting disability. Mean a ge of patients with partial to total disability was 47 years, while the mea n age of patients without lasting disability was 19.5 years (p = 0.013), No statistical correlation could be found between disability and sex, blunt v ersus penetrating injury, days to diagnosis, or number of embolization atte mpts. Conclusion: Patients sustaining head trauma with basilar skull fractures an d presenting with the described signs and symptoms should be evaluated for PTCCF, Risk of disability does not appear to be influenced by number of att empts at embolization or time to diagnosis, However, age may have a signifi cant impact on outcome.