Abstract
Since 1981, nine patients with carotid-cavernous fistula were treated by an intravascular occlusion technique. In these cases detachable balloon catheters were chosen for the treatment, using techniques almost identical to those described by Debrun. The balloon was introduced by the transcarotid route, inflated with metrizamide at a concentration of 240 mgI/ml, and detached without hardening materials. During the procedure, a Doppler ultrasonic flow detector was utilized for constant monitoring of the orbital bruit.
Internal carotid artery patency was preserved in 6 cases. In these cases, abducens nerve palsy disappeared within a week, whereas oculomotor nerve palsy persisted for two to three weeks. In two of the three remaining cases, internal carotid artery was permanently occluded with detachable balloons. Before the permanent occlusion, the intravascular occlusion test was performed by interrupting the carotid flow while monitoring the patient's neurologic signs. No ischemic sequelae were encountered. In the third case, no occlusion of either the fistula or internal carotid artery was accomplished. Thus, 8 of the 9 patients were considered to be successfully treated. Two patients, in whom carotid-cavernous fistula was selectively occluded, experienced a transient hemiparesis. In the eight successfully treated patients no recurrent symptoms were observed during the follow-up period, ranging between 7 and 26 months.
In conclusion, the detachable balloon catheterization technique proved very valuable in treating traumatic carotid-cavernous fistula by the intraarterial route.
