The Journal of the Arkansas Medical Society Issue 4 Volume 115 | Page 22

Conclusion
Carotid-Cavernous sinus fistula, is a known
but rare vascular complication from ruptured
intracranial aneurysm and craniomaxillofacial
trauma. These patients often suffer from multiple
complex conditions related to traumatic brain and
facial trauma, which may mask classic presenting
symptoms and cause delay in detecting carotid-
cavernous fistulas. CCFs are typically associated
with significant morbidity and, in some cases, are
associated with intracranial hemorrhage and even
death. Thus, early recognition and treatment is nec-
essary. Appropriate and timely treatment may lead
to complete resolution of symptoms. In this case,
early intervention for the asymptomatic aneurysm
may have reduced or even eliminated the risk of
CCF and its sequelae.
References
1. P. Schütz, P. Bosnjakovic, Y. B. Abulhasan and T.
Al-Sheikh, “Traumatic carotid-cavernous fistula
in a multiple facial fractures patient: case report
and literature review,” Dent Traumatol, vol. 30,
pp. 488-492, 2014.
2. J. Ellis, H. Goldstein, E. J. Connolly and P. Mey-
ers, “Carotid-cavernous fistulas,” Neurosurg
Focus, vol. E, no. 9, p. 32, 2012.
Figure 3: Interventional Radiology cerebral angiogram after intracranial coil
detachment revealing normal opacification of the intracranial vasculature and total
obliteration of the fistula.
to high blood flow, spontaneous thrombosis of di-
rect CCFs is very rare. Treatment for CCF includes
monitoring ophthalmic status and treating any
ophthalmic complications in addition to closure
of the CCF. The preferred method of closure for
intracranial aneurysm and CCFs is intravascular
embolization or, less commonly, open surgical pro-
cedures. According to multiple CCF case reports,
transarterial embolization with intravascular bal-
loons is the most effective procedure for treating
direct CCFs or CCFs arising from the external ca-
rotid artery, while transvenous embolization is the
most common approach for indirect CCF if treat-
ment is warranted. 2,7 The embolization procedure
may utilize coils, detachable balloons, stents, or
liquid embolic agents. 2,3 If endovascular emboli-
zation has failed, surgical treatment such as ICA
ligation or cavernous sinus packing is an option. 3
As mentioned, our patient underwent endovas-
cular embolization with multiple coils. More than
80% of patients who undergo endovascular treat-
ment for direct and indirect